TIPS覆膜支架释放相关参数与分流道失功能关系研究

发布时间：2018-08-08 19:38

【摘要】：[目的]探讨采用Fluency覆膜支架行经颈静脉肝内门腔静脉分流术(TIPS)中分流道支架两端参数与分流道失功能的关系。[方法]回顾性分析我院2014年09月到2016年09月采用单枚Fluency覆膜支架行TIPS的肝硬化门静脉高压症患者共43例,根据术中血管造影图及术后多层螺旋CT门脉(MSCTP)成像图测量分流道支架肝静脉端、门静脉端角度(al、a2),支架进入腔静脉的长度(L1),支架进入肝静脉及门静脉的总长度(L2、L4),肝静脉、门静脉穿刺点位置血管的宽度(L3、L5)。采用t检验或非参数检验分析其与通畅性的关系。[结果]43例患者均成功完成TIPS,随访期间肝性脑病发生率为18. 6%(8/43);术后6个月、12个月支架累积分流道通畅率分别为90. 7%、83.7%;al、a2与通畅性有统计学意义(P0.05) ; L2、R1(L2/L3)与通畅性有统计学意义(P0.05) ; L1、L4、R2 (L4/L5)与通畅性无统计学意义。[结论]1.使用Fluency覆膜支架行TIPS术后早、中期分流道功能障碍主要是由于支架两端盖帽。2.使用Fluency覆膜支架行TIPS适当增加支架两端角度可以提高术后分流道通畅率。3.支架进入肝静脉端长度超过2cm或达到肝静脉宽度两倍以上可以提高分流道通畅性。
[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.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

【参考文献】