發(fā)布時(shí)間：2018-06-13 21:52

  本文選題：TIPS + 裸支架　； 參考：《青海大學(xué)》2017年碩士論文

【摘要】：目的:對比TIPS術(shù)應(yīng)用不同類型支架治療肝硬化門脈高壓癥術(shù)后在肝功能、肝性腦病、分流道狹窄等并發(fā)癥方面的臨床應(yīng)用價(jià)值。方法:收集2014年10月至2016年4月食管胃底靜脈曲張破裂出血或頑固性腹水行TIPS術(shù)治療的患者共77例,將其隨機(jī)分為三組,其中單純覆膜支架組26例,雙裸支架組22例,擬Viatorr支架組(長裸+覆膜)29例,對77例患者進(jìn)行臨床觀察及隨訪,分別比較不同類型支架術(shù)前與術(shù)后門靜脈壓力變化情況,其隨訪時(shí)間分別為術(shù)后1周、1月、3月、6月、12月,觀察不同支架置入后在門靜脈壓力、支架通暢率、肝性腦病發(fā)生率、肝功能變化情況有無統(tǒng)計(jì)學(xué)差異。結(jié)果:1.77例均成功完成手術(shù),三組共置入支架128個(gè),其中覆膜支架55個(gè),裸支架73個(gè),三組觀察對象一般臨床資料、術(shù)前肝功能比較不存在統(tǒng)計(jì)學(xué)差異。2.術(shù)前門靜脈壓力為42.87±6.29cmH2O,術(shù)后門靜脈壓力降為26.23±4.82cmH2O,門靜脈術(shù)后較術(shù)前明顯降低,數(shù)值差異有統(tǒng)計(jì)學(xué)意義,且術(shù)前、術(shù)后門脈壓力在單覆膜支架組、雙裸支架組及擬Viatorr支架組無統(tǒng)計(jì)學(xué)差異;3.支架累積通暢率:三組術(shù)后在第1月、6月、12月累計(jì)的通暢率無統(tǒng)計(jì)學(xué)差異;4.肝性腦病:肝性腦病的累積發(fā)生率于1月、6月、12月行卡方檢驗(yàn),示三組間于1月、6月無統(tǒng)計(jì)學(xué)差異,于12月具有統(tǒng)計(jì)學(xué)意義,行四格表檢驗(yàn),單覆膜支架組與雙裸支架組及擬Viatorr支架組比較均具有統(tǒng)計(jì)學(xué)意義。5.肝功能:術(shù)前、術(shù)后1周、3月、12月計(jì)Child-pugh評分,于三組支架間分別比較術(shù)前與術(shù)后1周、3月、12月肝功能變化情況,行統(tǒng)計(jì)學(xué)分析示:三組支架術(shù)前與1周、3月均有統(tǒng)計(jì)學(xué)意義,雙裸支架組與擬Viatorr支架組在12月與術(shù)前無統(tǒng)計(jì)學(xué)意義;單覆膜支架組與雙裸支架組在術(shù)后1周與3月肝功能比較無統(tǒng)計(jì)學(xué)意義,擬Viatorr支架組在1周、3月、12月均有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.行單覆膜支架置入與雙支架(雙裸支架和擬Viatorr支架)對比,在門靜脈壓力、支架通暢率率方面不存在統(tǒng)計(jì)學(xué)差異。2.覆膜支架與雙支架(雙裸支架、擬Viatorr支架)比較,在遠(yuǎn)期肝性腦病發(fā)生率高。3.TIPS術(shù)會(huì)造成肝功能受損,術(shù)后在肝功能恢復(fù)情況上,單純覆膜支架明顯不如雙支架,雙裸支架較擬Viatorr支架恢復(fù)稍差,但在支架狹窄率及肝性腦病發(fā)生率上無明顯差異,考慮裸支架費(fèi)用低于明顯覆膜支架,在經(jīng)費(fèi)欠缺的時(shí)候考慮使用。
[Abstract]:Objective: to compare the clinical value of tips in the treatment of hepatic function, hepatic encephalopathy and shunt stenosis. Methods: from October 2014 to April 2016, 77 patients with esophageal variceal bleeding or refractory ascites treated with tips were randomly divided into three groups: 26 cases in simple covered stent group and 22 cases in double bare stent group. In the Viatorr stent group (29 cases), 77 patients were observed and followed up. The changes of portal vein pressure before and after operation of different types of stents were compared. The follow-up time was 1 week, 1 month, 3 months, 6 months and 12 months, respectively. The portal vein pressure, the patency rate of stent, the incidence of hepatic encephalopathy and the changes of liver function were observed. Results one hundred and seventy-seven cases were successfully operated on, 128 stents were implanted in the three groups, including 55 covered stents and 73 bare stents. There was no significant difference in liver function between the three groups. The preoperative portal vein pressure was 42.87 鹵6.29 cmH _ 2O, and the postoperative portal vein pressure was 26.23 鹵4.82 cm _ H _ 2O. There was no significant difference between the two bare stent groups and the Viatorr stent group. The cumulative patency rate of stent: there was no significant difference in the cumulative patency rate between the three groups in the 1st, 6th and 12th months after operation. Hepatic encephalopathy: the cumulative incidence of hepatic encephalopathy was measured by chi-square test in January, June and December. There was no statistical difference between the three groups in January and June. There were significant differences among single covered stent group, double bare stent group and Viatorr stent group. Liver function: Child-pugh score was calculated before operation, 1 week, 3 months and 12 months after operation. The changes of liver function were compared between the three groups before and after 1 week, 3 months and 12 months, respectively. The results of statistical analysis showed that the three groups had statistical significance before and after 1 week and 3 months. There was no significant difference in liver function between single covered stent group and double bare stent group in 1 week and 3 months after operation, but there was statistical significance in Viatorr stent group at 1 week, 3 months and 12 months after operation. Conclusion 1. There was no significant difference in portal vein pressure and patency rate between single covered stent and double stent (double bare stent and Viatorr like stent). Compared with double stents (double bare stents, Viatorr stents), membrane-coated stents have a higher incidence of hepatic encephalopathy in the long term. 3. Tips may cause damage to liver function. In the case of recovery of liver function after operation, simple coated stents are obviously inferior to double stents. The recovery of double bare stent was a little worse than that of Viatorr stent, but there was no significant difference in the rate of stent stenosis and hepatic encephalopathy. The cost of bare stent was lower than that of obvious covered stent.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575.2

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