目的 评价不同直径覆膜支架行经颈静脉肝内门体分流术(TIPS)治疗食管胃底静脉曲张破裂出血(EGVB)的疗效与安全性.方法 收集2010年12月至2015年2月因EGVB接受TIPS治疗的68例肝硬化门静脉高压症患者临床资料,其中30例使用直径7mm覆膜支架(小支架组),38例使用直径8mm覆膜支架(大支架组).采用Kaplan-Meier法分析两组患者累积无消化道再出血率、分流道通畅率和生存率,进一步组间比较采用Log-rank检验,肝性脑病发生率比较采用x2检验.结果 68例患者手术成功率为100％.术后随访0.1～52.3个月,平均(19.4±16.0)个月.术后3、6、12个月累积无消化道再出血率,在小支架组分别为86.54％、79.30％、74.90％,大支架组分别为91.87％、85.93％、81.63％,两组差异无统计学意义(X2=0.05,P=0.83);分流道累积通畅率,在小支架组分别为95.00％、80.19％、70.17％,大支架组分别为96.15％、91.97％、81.07％,两组差异无统计学意义(x2=0.40,P=0.53);术后3、12、24、48个月累积生存率,在小支架组分别为93.33％、86.67％、75.11％、64.38％,大支架组分别为97.37％、94.23％、88.68％、76.02％,两组差异无统计学意义(x2=2.21,P=0.14);术后出现肝性脑病15例(15/68,22.06％),小支架组、大支架组发生率分别为20.00％(6/30)、23.68％(9/38),差异无统计学意义(X2=0.13,P=0.72).结论 与直径7mm覆膜支架相比,采用直径8mm覆膜支架行TIPS术治疗EGVB并未提高疗效及降低肝性脑病发生率.%Objective To assess the efficacy and safety of different diameter covered stents used in transjugular intrahepatic portosystemic shunt (TIPS) for esophagogastric varices with bleeding (EGVB). Methods The clinical data of 68 patients with portal hypertension due to cirrhosis, who received TIPS for EGVB during the period from Desember 2010 to February 2015, were retrospectively analyzed. Among the 68 patients, covered stent with diameter of 7mm was used in 30 (small stent group) and covered stent with diameter of 8mm was employed in 38 (big stent group). Using Kaplan-Meier method, the cumulative digestive tract no-rebleeding rate, the patency rate of shunt and the survival rate of both groups were analyzed. Logrank test was used to make comparison between the two groups, and chi-square test was conducted to compare the incidence of hepatic encephalopathy between the two groups. Results The operative success rate was 100％ in 68 patients. The patients were followed up for 0.1-52.3 months, with a mean of (19.4±16.0) months. The 3-, 6-and 12-month cumulative digestive tract no-rebleeding rates were 86.54％, 79.30％ and 74.90％ respectively in the small stent group, which were 91.87％, 85.93％ and 81.63％ respectively in the big stent group, but the differences between the two groups were not statistically significantly (X2=0.05, P=0.83). The 3-, 6-and 12-month cumulative patency rates of shunt in the small stent group were 95.00％, 80.19％ and 70.17％ respectively, which in the big stent group were 96.15％, 91.97％ and 81.07％ respectively, and no statistically significant differences existed between the two groups (X2=0.40, P=0.53). The 3-, 12-, 24-and 48-month cumulative survival rates in the small stent group were 93.33％, 86.67％, 75.11％ and64.38％ respectively, while those in the big stent group were 97.37％, 94.23％, 88.68％ and 76.02％ respectively, and the differences between the two groups were not statistically significantly (X2=2.21, P=0.14). Postoperative hepatic encephalopathy occurred in 15 patients (15/68, 22.06％), the incidences of hepatic encephalopathy in the small stent group and in the big stent group were 20.00％ (6/30) and 23.68％ (9/38) respectively, the difference between the two groups was not statistically significantly (X2=0.13, P=0.72). Conclusion Compared with the use of 7mm covered stent, the use of 8mm covered stent in TIPS neither can improve the curative effect nor can reduce the incidence of hepatic encephalopathy.
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