【摘要】：目的探討覆膜支架彈性回直致經(jīng)頸靜脈肝內(nèi)門體分流術(shù)(TIPS)分流道失功能的原因。方法回顧性分析2008年1月至2015年12月共31例行介入下分流道修復患者資料。根據(jù)兩次介入手術(shù)DSA影像資料對比將31例患者分為彈性回直組(A組=16例),與非彈性回直組(B組=15例)。37例TIPS術(shù)后隨訪時間超過2年且分流道通暢患者設為對照組(C組)。對比分析各組患者臨床資料,測量覆膜支架肝靜脈端、門靜脈端與肝實質(zhì)分流道的夾角分別記為α、β角,觀察各組覆膜支架肝靜脈端覆蓋情況。結(jié)果 A組一期通暢時間(18.9±14.6)個月,B組一期通暢時間(4.0±4.8)個月,C組隨訪時間為(30.6±5.9)個月,差異有統(tǒng)計學意義(P0.001)。各組間性別、年齡、TIPS適應癥、肝硬化病因差異均無統(tǒng)計學意義。各組間α角差異無統(tǒng)計學意義。A組β角167.2°±8.9°,B組β角164.5°±21.3°,C組β角175.5°±8.1°,差異有統(tǒng)計學意義(P=0.007)。A組44%覆膜支架覆蓋至肝靜脈開口,B組67%覆膜支架覆蓋至肝靜脈開口,C組92%覆膜支架覆蓋至肝靜脈開口,差異有統(tǒng)計學意義(P0.001)。Logistic回歸分析顯示β角(OR=0.929,P=0.010)、覆膜支架覆蓋至肝靜脈開口(OR=0.100,P=0.002)與TIPS分流道失功能相關。結(jié)論覆膜支架彈性回直是TIPS術(shù)后中遠期分流道失功能的主要因素。覆膜支架門靜脈端彎曲角度過大、覆膜支架肝靜脈端長度過短是覆膜支架彈性回直致分流道失功能的重要原因。
[Abstract]:Objective to investigate the causes of (TIPS) shunt dysfunction after intrahepatic portosystemic shunt through jugular vein induced by elastic return of covered stent. Methods the data of 31 patients with interventional shunt repair from January 2008 to December 2015 were retrospectively analyzed. According to the DSA imaging data of two interventional operations, 31 patients were divided into elastic return group (group A = 16 cases). 37 cases of TIPS were followed up for more than 2 years and shunt patency was established as control group (group C). The clinical data of each group were compared and analyzed. The angle of hepatic vein end, portal vein end and hepatic parenchymal shunt pathway were recorded as 偽 and 尾 angles respectively. Results the primary patency time was (18.9 鹵14.6) months in group A, (4.0 鹵4.8) months in group B, and (30.6 鹵5.9) months in group C (P 0.001). There was no significant difference in sex, age, TIPS indication and etiology of liver cirrhosis among groups. There was no significant difference in 偽 angle between groups A (167.2 擄鹵8.9 擄), B (164.5 擄鹵21.3 擄) and C (175.5 擄鹵8.1 擄). In group B, 67% of the covered stents were covered to the opening of hepatic vein, and 92% of the covered stents of group C were covered to the opening of hepatic veins. The difference was statistically significant (P0.001). Logistic regression analysis showed 尾 angle (OR=0.929,P=0.010). The coverage of the covered stent to the hepatic vein opening (OR=0.100,P=0.002) was related to the dysfunction of the shunt of TIPS. Conclusion Elastic recanalization of covered stent is the main factor of long-term shunt dysfunction after TIPS. The great bending angle of portal vein end and short length of hepatic vein end of covered stent are the important reasons for shunt dysfunction caused by elastic return of covered stent.
【作者單位】： 南方醫(yī)科大學南方醫(yī)院介入科;
【分類號】：R575.2

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