Fluency覆膜支架行TIPS术后支架狭窄原因分析

发布时间：2018-06-13 18:18

本文选题：门静脉高压症 + 经颈静脉肝内门体分流　；参考：《介入放射学杂志》2015年12期

【摘要】：目的分析Fluency覆膜支架行经颈静脉肝内门体分流术(TIPS)后支架狭窄发生原因,探讨术中支架最佳释放位置,以进一步提高临床疗效。方法收集2008年6月至2012年6月采用Fluency覆膜支架行TIPS治疗的肝硬化门静脉高压症患者124例,术中均仅接受1枚Fluency覆膜支架,且支架直径均为8 mm。术后3、6个月,1、2、3、4、5年定期随访行超声及多层螺旋CT检查,根据分流道狭窄诊断标准评估是否存在支架功能障碍及门静脉高压复发,必要时行直接门静脉造影,球囊扩张或支架植入修复分流道。结果 124例患者手术成功率为100%,术后门静脉内径和门静脉压力均显著降低。随访期间共有35例患者(28.23%)发生支架狭窄,其中22例为肝静脉端狭窄,12例为门静脉端狭窄,1例为支架完全闭塞;经门静脉右支分流术后支架狭窄发生率为35.62%(26/73),经门静脉左支分流术后支架狭窄发生率为17.65%(9/51),两者间差异有统计学意义(P=0.029)。结论 Fluency覆膜支架行TIPS术后支架狭窄多发生在支架两端,与分流道位置选择、支架长度、支架成角角度、释放位置等因素相关,高发时间窗为术后6~24个月。选择门静脉左支分流、最合适支架尺寸并精准释放,可降低术后支架狭窄发生率。
[Abstract]:Objective to analyze the causes of stenting stenosis after fluency covered stent via jugular intrahepatic portosystemic shunt (TIPS), and to explore the optimal position of stent release in order to further improve the clinical efficacy. Methods from June 2008 to June 2012, 124 patients with portal hypertension of cirrhosis were treated with fluency stent. Only one fluency stent was used during the operation, and the diameter of the stent was 8 mm. The patients were followed up for 5 years with ultrasound and multi-slice spiral CT. According to the diagnostic criteria of shunt duct stenosis, the stent dysfunction and portal hypertension recurrence were evaluated, and direct portal vein angiography was performed when necessary. Balloon dilatation or stent implantation to repair the shunt. Results the successful rate of operation in 124 patients was 100 and the diameter of portal vein and pressure of portal vein decreased significantly after operation. During the follow-up period, 35 patients (28.23) had stenting stenosis, of which 22 cases were hepatic vein stenosis and 12 cases were portal vein stenosis. 1 case was stenting complete occlusion. The incidence of stent stenosis after right portal vein shunt was 35.62 / 73 and 17.65 / 51g respectively. The difference between the two groups was statistically significant (P = 0.029). Conclusion Stent stenosis occurred at both ends of stent after fluency stent implantation with tips, which was related to shunt location, stent length, stent angle, release position and so on. The high incidence time window was 6 ~ 24 months after operation. Selection of left portal vein shunt, the most suitable stent size and accurate release, can reduce the incidence of stent stenosis.
【作者单位】：昆明医科大学第二附属医院介入放射科;
【基金】：云南省卫生科技计划项目(2012WS0107、2014NS0112)
【分类号】：R575;R815

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