对比单覆膜支架与双支架在TIPS术后的临床应用研究

发布时间：2018-06-13 21:52

本文选题：TIPS + 裸支架　；参考：《青海大学》2017年硕士论文

【摘要】：目的:对比TIPS术应用不同类型支架治疗肝硬化门脉高压症术后在肝功能、肝性脑病、分流道狭窄等并发症方面的临床应用价值。方法:收集2014年10月至2016年4月食管胃底静脉曲张破裂出血或顽固性腹水行TIPS术治疗的患者共77例,将其随机分为三组,其中单纯覆膜支架组26例,双裸支架组22例,拟Viatorr支架组(长裸+覆膜)29例,对77例患者进行临床观察及随访,分别比较不同类型支架术前与术后门静脉压力变化情况,其随访时间分别为术后1周、1月、3月、6月、12月,观察不同支架置入后在门静脉压力、支架通畅率、肝性脑病发生率、肝功能变化情况有无统计学差异。结果:1.77例均成功完成手术,三组共置入支架128个,其中覆膜支架55个,裸支架73个,三组观察对象一般临床资料、术前肝功能比较不存在统计学差异。2.术前门静脉压力为42.87±6.29cmH2O,术后门静脉压力降为26.23±4.82cmH2O,门静脉术后较术前明显降低,数值差异有统计学意义,且术前、术后门脉压力在单覆膜支架组、双裸支架组及拟Viatorr支架组无统计学差异;3.支架累积通畅率:三组术后在第1月、6月、12月累计的通畅率无统计学差异;4.肝性脑病:肝性脑病的累积发生率于1月、6月、12月行卡方检验,示三组间于1月、6月无统计学差异,于12月具有统计学意义,行四格表检验,单覆膜支架组与双裸支架组及拟Viatorr支架组比较均具有统计学意义。5.肝功能:术前、术后1周、3月、12月计Child-pugh评分,于三组支架间分别比较术前与术后1周、3月、12月肝功能变化情况,行统计学分析示:三组支架术前与1周、3月均有统计学意义,双裸支架组与拟Viatorr支架组在12月与术前无统计学意义;单覆膜支架组与双裸支架组在术后1周与3月肝功能比较无统计学意义,拟Viatorr支架组在1周、3月、12月均有统计学意义。结论:1.行单覆膜支架置入与双支架(双裸支架和拟Viatorr支架)对比,在门静脉压力、支架通畅率率方面不存在统计学差异。2.覆膜支架与双支架(双裸支架、拟Viatorr支架)比较,在远期肝性脑病发生率高。3.TIPS术会造成肝功能受损,术后在肝功能恢复情况上,单纯覆膜支架明显不如双支架,双裸支架较拟Viatorr支架恢复稍差,但在支架狭窄率及肝性脑病发生率上无明显差异,考虑裸支架费用低于明显覆膜支架,在经费欠缺的时候考虑使用。
[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 卤6.29 cmH _ 2O, and the postoperative portal vein pressure was 26.23 卤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.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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