采用Viatorr覆膜支架行经颈静脉肝内门体分流术

摘要

目的 评价采用Viatorr覆膜支架行经颈静脉肝内门体分流术(TIPS)治疗门静脉高压并发症的疗效与安全性.方法 回顾性分析8例接受Viatorr覆膜支架TIPS治疗的肝硬化门静脉高压症患者的资料.术后进行随访,复查上腹部CT,以评价TIPS疗效.结果 对8例患者均成功手术,均采用直径8 mm、覆膜段长度50～80 mm的Viatorr覆膜支架建立肝内分流道.对其中1例合并门静脉海绵样变的患者于门静脉端置入8 mm× 40 mm的E-Luminexx裸支架1枚;1例患者因肝静脉端狭窄于肝静脉端置入8 mm×40 mm的Fluency覆膜支架1枚.术后患者门静脉压力由术前的[33.08(29.32,40.22)]mmHg降为[23.31(21.43,26.51)]mmHg,差异有统计学意义(Z=-2.52,P=0.012).术后随访1,1～7.7个月,所有患者均存活,均未再发生门静脉高压相关并发症.术后2例患者发生肝性脑病.术后1～7.7个月复查示所有患者TIPS分流道通畅.结论 对国内肝硬化门静脉高压症患者应用Viatorr支架行TIPS治疗安全、有效.%Objective To assess the efficacy and safety of transjugular intrahepatic portasystemic shunt (TIPS) with Viatorr covered stent in patients with portal hypertension-related complications.Methods Clinical data of 8 patients with por-tal hypertension-related complications were analyzed retrospectively.All the cases received TIPS with Viatorr covered stent.After the operation,the followed up was used to evaluate the therapeutic effect of TIPS by enhanced CT scan.Results All the operations of TIPS were technically successful.And all the cases were treated with Viatorr covered stents with diameter of 8 mm and covered segment length of 50-80 mm.For 1 case with cavernous transformation of portal vein,a 8 mm×40 mm E-Luminexx bare stent was implanted in the portal vein side.For 1 case with hepatic vein stenosis,a 8 mm× 40 mm Fluency covered stent was implanted in the hepatic vein side.After the operation,the portal pressure reduced from (33.08 [29.32,40.22])mmHg (preoperative) to (23.31 [21.43,26.51])mmHg (postoperative) with statistical difference (Z=-2.52,P=0.012).The patients were followed up for 1.1-7.7 months,and all the patients were alive without complications of portal hypertension.There were 2 cases with mild hepatic encephalopathy after operation.During the reexamination time of 1-7.7 months,all TIPS shunts remained patency.Conclusion TIPS with Viatorr stent is a safe and effective treatment for patients with portal hypertension-related complications.