【摘要】：[目的]探討采用Fluency覆膜支架行經(jīng)頸靜脈肝內(nèi)門腔靜脈分流術(shù)(TIPS)中分流道支架兩端參數(shù)與分流道失功能的關(guān)系。[方法]回顧性分析我院2014年09月到2016年09月采用單枚Fluency覆膜支架行TIPS的肝硬化門靜脈高壓癥患者共43例,根據(jù)術(shù)中血管造影圖及術(shù)后多層螺旋CT門脈(MSCTP)成像圖測量分流道支架肝靜脈端、門靜脈端角度(al、a2),支架進(jìn)入腔靜脈的長度(L1),支架進(jìn)入肝靜脈及門靜脈的總長度(L2、L4),肝靜脈、門靜脈穿刺點位置血管的寬度(L3、L5)。采用t檢驗或非參數(shù)檢驗分析其與通暢性的關(guān)系。[結(jié)果]43例患者均成功完成TIPS,隨訪期間肝性腦病發(fā)生率為18. 6%(8/43);術(shù)后6個月、12個月支架累積分流道通暢率分別為90. 7%、83.7%;al、a2與通暢性有統(tǒng)計學(xué)意義(P0.05) ; L2、R1(L2/L3)與通暢性有統(tǒng)計學(xué)意義(P0.05) ; L1、L4、R2 (L4/L5)與通暢性無統(tǒng)計學(xué)意義。[結(jié)論]1.使用Fluency覆膜支架行TIPS術(shù)后早、中期分流道功能障礙主要是由于支架兩端蓋帽。2.使用Fluency覆膜支架行TIPS適當(dāng)增加支架兩端角度可以提高術(shù)后分流道通暢率。3.支架進(jìn)入肝靜脈端長度超過2cm或達(dá)到肝靜脈寬度兩倍以上可以提高分流道通暢性。
[Abstract]:[objective] to investigate the relationship between the two end parameters of shunt stents and the dysfunction of shunt channels in (TIPS) with Fluency covered stent in transjugular intrahepatic portal vena cava shunt (TIPS). [methods] A retrospective analysis was made on 43 patients with portal hypertension due to cirrhosis who underwent TIPS with a single Fluency stent from September 2014 to September 2016. According to intraoperative angiography and multislice spiral CT portal vein (MSCTP) imaging, the angle of hepatic vein, portal vein end (Ala _ 2), length of stent into vena cava (L _ 1), total length of stent into hepatic vein and portal vein (L _ 2 / L _ 4), hepatic vein were measured. The width of the blood vessel at the point of portal vein puncture (L _ 3 / L _ 5). T-test or non-parametric test is used to analyze the relationship between it and the fluidity. [results] all 43 patients successfully completed TIPS.The incidence of hepatic encephalopathy during follow-up was 18. 5%. 6% (8 / 43), 6 months after operation, 12 months after the stent cumulative shunt patency rate were 90. 5%. There was significant difference between the two groups (P0.05); L2OR1 (L2/L3) and the patency (P0.05); L1C L4R 2 (L4/L5) and the patency were not statistically significant (P0.05), but there was no significant difference between L2R1 (L2/L3) and patency (P0.05). [conclusion] 1. The early and middle stage shunt dysfunction after TIPS with Fluency covered stent was mainly due to the cap. 2. 2 at both ends of the stent. Using Fluency covered stent with TIPS to increase the angle between the two ends of the stent can improve the patency rate of shunt. 3. When the stent enters the hepatic vein longer than 2cm or more than twice the width of the hepatic vein, the patency of shunt can be improved.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R575.2

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