Sauer P, Theilmann L, Herrmann S, Bruckner T, Roeren T, Richter G, Stremmel W, Stiehl A
Department of Internal Medicine, University of Heidelberg, Germany.
Hepatology. 1996 Dec;24(6):1433-6. doi: 10.1002/hep.510240622.
Development of stenosis or occlusion of the transjugular intrahepatic portosystemic stent shunt (TIPSS) is one of the major limiting factors in the long-term viability of this procedure. The efficacy of anticoagulation with heparin which is used in different centers is still unclear. In the present study, we evaluated the effect of phenprocoumon on shunt patency after TIPSS placement using Palmaz stents; 49 patients with Child's A and B cirrhosis, who underwent successful TIPSS placement were randomized into the treatment group (n = 24) who received phenprocoumon and a control group (n = 25). After 11 to 13 weeks, all patients were admitted and had a reevaluation that included control angiography by transjugular approach. Phenprocoumon treatment was stopped after the first reevaluation and both groups were followed for 1 year after randomization. During the 3-month treatment period 11 of 22 patients of the treatment group and 12 of 23 patients of the control group required reintervention because of an increased portosystemic gradient. Five of the 12 patients in the control group showed complete occlusion of the shunt, whereas no occlusion in the treatment group was observed (P < .05). During the mean follow-up of 8 months after the treatment was stopped, in both groups stenosis occurred in 50% of patients, but no further occlusion of the stent was observed. These data indicate that occlusion of the stent is related to thrombosis, whereas stenosis does not appear to be dependent on blood coagulation. In patients with preserved liver function occlusion of the shunt may be prevented by phenprocoumon treatment in the first 3 months after TIPSS placement. Thereafter shunt occlusion was not observed and further phenprocoumon treatment seemed unnecessary.
经颈静脉肝内门体分流术（TIPSS）狭窄或闭塞的发生是该手术长期生存的主要限制因素之一。不同中心使用肝素进行抗凝的效果仍不明确。在本研究中，我们评估了苯丙香豆素对使用帕尔马支架进行TIPSS植入术后分流道通畅性的影响；49例Child's A级和B级肝硬化且成功进行TIPSS植入的患者被随机分为接受苯丙香豆素治疗的治疗组（n = 24）和对照组（n = 25）。11至13周后，所有患者入院并重新评估，包括经颈静脉途径进行对照血管造影。首次重新评估后停止苯丙香豆素治疗，两组在随机分组后随访1年。在3个月的治疗期内，治疗组22例患者中有11例、对照组23例患者中有12例因门体压力梯度增加需要再次干预。对照组12例患者中有5例分流道完全闭塞，而治疗组未观察到闭塞情况（P <.05）。在停止治疗后的平均8个月随访期内，两组均有50%的患者出现狭窄，但未观察到支架进一步闭塞。这些数据表明，支架闭塞与血栓形成有关，而狭窄似乎不依赖于血液凝固。对于肝功能良好的患者，在TIPSS植入后的前3个月内使用苯丙香豆素治疗可预防分流道闭塞。此后未观察到分流道闭塞，似乎无需进一步使用苯丙香豆素治疗。
