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目的探讨经颈静脉肝内门体分流术(TIPS)中采用裸支架联合覆膜支架建立分流道的中远期疗效。方法回顾性分析我院连续71例采用裸支架+覆膜支架方式建立TIPS分流道的患者资料。术中均采用8mm直径支架建立分流道,首先置入相应长度裸支架,再于其内置入同等直径覆膜支架,覆膜支架长度小于裸支架2cm,使分流道远心端门静脉内2cm为裸区,近心端裸支架与覆膜支架平齐达下腔静脉开口部。分析术后分流道通畅率、肝性脑病发生率及生存率。结果对所有患者均成功建立肝内分流道。术前、术后门静脉压力分别为(3.67±0.82)kPa、(2.31±0.62)kPa(P<0.01)。随访2~63个月,平均(25.83±11.34)个月;共置入裸支架76枚,覆膜支架73枚;术后1、2、3年的分流道通畅率为87%、72%、61%,肝性脑病发生率为16%、34%、46%,生存率为83%、74%、67%。结论采用裸支架联合覆膜支架方式建立TIPS分流道的中远期疗效与TIPS专用覆膜支架近似,可作为必要时的替代产品。
Objective To investigate the long-term effect of establishing a shunt with bare stent and stent-graft in transjugular intrahepatic portosystemic shunt (TIPS). Methods A retrospective analysis of 71 consecutive patients in our hospital with bare stent + stent-graft approach to establish TIPS shunt data. Surgery are used to establish shunt 8mm diameter stent, first placed into the corresponding length of bare stent, and then placed in the same diameter stent graft, stent graft stent length less than bare 2cm, so that the distal shunt portal venous 2cm naked District, near the end of the bare end of the stent and stent-covered stent vena cava openings. Analysis of postoperative shunt patency rate, hepatic encephalopathy incidence and survival rate. Results All patients were successfully established intrahepatic shunt. Preoperative and postoperative portal venous pressure were (3.67 ± 0.82) kPa and (2.31 ± 0.62) kPa, respectively (P <0.01). The follow-up ranged from 2 to 63 months, with an average of (25.83 ± 11.34) months. There were 76 bare stents and 73 stent-grafts. The shunt patency rates at 1, 2 and 3 years were 87%, 72% 61%, the incidence of hepatic encephalopathy was 16%, 34%, 46%, the survival rate was 83%, 74%, 67%. Conclusion The long-term efficacy of TIPS shunt with bare stent combined with stent-graft is similar to that of TIPS stent, which can be used as an alternative if necessary.