裸金属支架与PTFE-覆膜支架行TIPSS治疗门静脉高压症患者临床疗效对比研究

摘要

目的 使用裸金属支架(BMS)和聚四氟乙烯(PTFE)覆膜支架行经颈静脉肝内门腔静脉支架分流术(TIPSS)治疗门静脉高压症患者临床疗效和技术设备成本对比分析.方法 2010年5月~2015年6月对163例门静脉高压症患者行TIPSS术,患者平均年龄为(56±12)岁,女性占32.9%.其中接受BMS支架80例,接受覆膜支架83例.结果 本组技术成功率为97.5%,术后门体梯度压从(16.1±4.8)mmHg下降至(5.1±2.1)mmHg;两组技术成功率和门体梯度压降无显著性差异;Kaplan-Meier分析显示,两组14 d、6 m和2 a一期支架通畅率存在显著性差别,其中PTFE-覆膜支架组通畅率高;两组1 a生存率和肝性脑病发生率无显著性差异;金属支架和覆膜支架总成本分别为66570元和70455元.结论 TIPSS术是一种安全、有效的治疗门静脉高压症的方法.裸金属支架和PTFE-覆膜支架均具有良好的技术和临床效果,并发症发生率低.%Objective To compare the technical and clinical efficacy of bare metal stent (BMS) and polytetrafluoroethylene (PTFE)-stentgraft of transjugular intrahepatic portosystemic shunt (TIPSS) in treatment of patients with portal hypertension (PH). Methods 163 patients (56 ±12 ys,32.9 % females) with PH receiving TIPSS were recuited in this study,and 80 patients received BMS and 83 received PTFE-stentgraft. Results The technical success rate was 97.5% due to four unsuccessful interventions. The portosystemic gradient decreased from (16.1 ±4.8) mmHg to (5.1 ±2.1) mmHg in the successful series. There was no significant differences as respect to technical success rate and portosystemic gradient decrease between the two groups;Kaplan-Meier analysis yielded significant differences in primary patency after 14 days,6 months and 2 years thereafter in favour of the stentgraft;Both groups showed good clinical results without significant difference in 1-year survival and hepatic encephalopathy occurrence;Costs to establish TIPSS and maintain 2-year follow-up for constant patency were 66570 yuan in BMS group and 70455 yuan in PTFE-stentgraft. Conclusion TIPSS is a safe and effective procedure to manage portal hypertension. Both BMS stent and PTFE-stentgraft enable good technical and clinical outcomes with low complication rate,while the primary patency rate is clearly in favour of the stentgraft with a relative high costs.