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覆膜支架弹性回直致TIPS分流道失功能原因分析

发布时间:2018-11-13 07:25
【摘要】:目的探讨覆膜支架弹性回直致经颈静脉肝内门体分流术(TIPS)分流道失功能的原因。方法回顾性分析2008年1月至2015年12月共31例行介入下分流道修复患者资料。根据两次介入手术DSA影像资料对比将31例患者分为弹性回直组(A组=16例),与非弹性回直组(B组=15例)。37例TIPS术后随访时间超过2年且分流道通畅患者设为对照组(C组)。对比分析各组患者临床资料,测量覆膜支架肝静脉端、门静脉端与肝实质分流道的夹角分别记为α、β角,观察各组覆膜支架肝静脉端覆盖情况。结果 A组一期通畅时间(18.9±14.6)个月,B组一期通畅时间(4.0±4.8)个月,C组随访时间为(30.6±5.9)个月,差异有统计学意义(P0.001)。各组间性别、年龄、TIPS适应症、肝硬化病因差异均无统计学意义。各组间α角差异无统计学意义。A组β角167.2°±8.9°,B组β角164.5°±21.3°,C组β角175.5°±8.1°,差异有统计学意义(P=0.007)。A组44%覆膜支架覆盖至肝静脉开口,B组67%覆膜支架覆盖至肝静脉开口,C组92%覆膜支架覆盖至肝静脉开口,差异有统计学意义(P0.001)。Logistic回归分析显示β角(OR=0.929,P=0.010)、覆膜支架覆盖至肝静脉开口(OR=0.100,P=0.002)与TIPS分流道失功能相关。结论覆膜支架弹性回直是TIPS术后中远期分流道失功能的主要因素。覆膜支架门静脉端弯曲角度过大、覆膜支架肝静脉端长度过短是覆膜支架弹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 伪 and 尾 angles respectively. Results the primary patency time was (18.9 卤14.6) months in group A, (4.0 卤4.8) months in group B, and (30.6 卤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 伪 angle between groups A (167.2 掳卤8.9 掳), B (164.5 掳卤21.3 掳) and C (175.5 掳卤8.1 掳). 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.
【作者单位】: 南方医科大学南方医院介入科;
【分类号】:R575.2

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