Clinical Efficacy of Transjugular Intrahepatic Portosystemic Shunt Created with Expanded Polytetrafluoroethylene-Covered Stent-Grafts: 8-mm Versus 10-mm
Clinical Efficacy of Transjugular Intrahepatic Portosystemic Shunt Created with Expanded Polytetrafluoroethylene-Covered Stent-Grafts: 8-mm Versus 10-mm
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使用扩张型聚四氟乙烯覆盖覆膜支架创建经颈静脉肝内门体分流术的临床疗效：8 毫米与 10 毫米
DOI：
10.1007/s00270-019-02162-4
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发表时间：
2019-05-01
影响因子：
2.9
通讯作者：
Yang, Li
中科院分区：
文献类型：
--
作者：
Luo, Xuefeng;Wang, Xiaoze;Yang, Li
目的：关于肝硬变患者建立经颈静脉肝内门体分流术(TIPS)的合适分流直径存在争议的数据。本研究旨在比较直径为8 mm和10 mm的支架置入术预防静脉曲张再出血的临床疗效。方法对2011年12月至2015年6月期间成功实施TIPS技术预防静脉曲张再出血的肝硬化患者进行回顾性研究。34名患者使用8 mm的TIPS，380名患者使用10 mm的TIPS。结果两组患者的基线特征具有可比性。两组静脉曲张再出血率差异无统计学意义。8 mm组和10 mm组1、3年后再出血累积发生率分别为6.4%和35.5%、14.2%和24.9%(P= 0.663)。8 mm针尖较10 mm针尖肝性脑病(HE)发生率显著降低(1年16.1vs.32.6%，3年27.8vs.53.2%，P= 0.034)。两组的累积存活率相似：8 mm TIPS组1年和3年存活率分别为93.3%和79.6%，10 mm TIPS组1年和3年存活率分别为87.3%和72.1%(P= 0.451)。与10 mm支架相比，使用8 mm支架移植物可以降低HE发生率，尽管没有观察到生存益处。
PurposeConflicting data exist regarding the appropriate shunt diameter for transjugular intrahepatic portosystemic shunt (TIPS) creation in cirrhotic patients. This study was designed to compare the clinical efficacy of TIPS using stent-grafts with 8- and 10-mm diameters.MethodsIn this retrospective study, cirrhotic patients who underwent TIPS technical successfully for the prevention of variceal rebleeding from December 2011 to June 2015 were included. Thirty-four patients with 8-mm TIPS and 380 patients with 10-mm TIPS were identified. Propensity score matching method produced 32 patients in each group for comparison.ResultsBaseline characteristics between two groups were comparable. There was no significant difference in variceal rebleeding rate between the two groups. The cumulative incidence of variceal rebleeding after 1 and 3 years was 6.4% and 35.5% in the 8-mm group, respectively, and 14.2% and 24.9% in the 10-mm group, respectively (P= 0.663). 8-mm TIPS conferred a significant decrease in hepatic encephalopathy (HE) rate compared with the 10-mm TIPS (16.1 vs. 32.6% at 1 year, 27.8 vs. 53.2% at 3 years,P= 0.034). The cumulative survival rates were similar between the two groups: 93.3% and 79.6% at 1 and 3 years, respectively, in the 8-mm TIPS group vs. 87.3% and 72.1% at 1 and 3 years, respectively, in the 10-mm TIPS group (P= 0.451).ConclusionThe placement of 8-mm TIPS was sufficient to decompress the portal hypertension and prevent variceal rebleeding. The use of the 8-mm stent-graft can decrease HE rates compared with 10-mm stent-graft, although no survival benefit was observed.