Viatorr支架TIPS术治疗肝硬化门静脉高压伴上消化道出血的效果分析

摘要/Abstract

摘要： 目的观察肝硬化门静脉高压(PHT)伴上消化道出血(UGB)患者经颈静脉肝内门腔静脉分流术(TIPS)术中使用Viatorr支架的临床疗效与安全性。方法选择2017年11月—2020年12月无锡市第五人民医院收治的肝硬化PHT伴UGB患者32例作为研究对象,全部患者均接受Viatorr支架TIPS术治疗并经门诊随访;观察患者Viatorr支架植入成功率,比较患者术前、术后门静脉压力指标[门静脉压力梯度(PPG)、门静脉压力(PVP)、门静脉流速(PVV)],观察术前、术后1周、术后1个月、术后6个月患者血常规[血小板计数(PLT)、血红蛋白(Hb)、白细胞计数(WBC)]、肝肾功能[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、白蛋白(Alb)、总胆红素(TBil)、血肌酐(Scr)、尿素氮(BUN)]、凝血功能[凝血酶原时间(PT)]变化,统计患者术后6个月内再出血、肝性脑病及分流道狭窄等不良事件发生情况。结果 32例肝硬化PHT伴UGB患者Viatorr支架植入成功32例,植入成功率为100%(32/32);术后3 d,患者PVV、PVP分别为(51.28 ± 10.46)cm/s、(2.17 ± 0.63)mmHg,高于术前(29.78 ± 7.65)cm/s、(3.32 ± 0.84)mmHg,PPG为(12.75 ± 4.13)mmHg,低于术前(21.46 ± 6.28)mmHg(P<0.05);术后1周至术后6个月,患者PLT、Hb及WBC水平较术前逐渐升高(P<0.05);术后1周,患者ALT、AST、TBil、PT较术前升高,Alb较术前降低,术后1个月、6个月ALT、AST、TBil、PT逐渐回落,Alb逐渐回升(P<0.05);术后1周、1个月、6个月,患者Scr、BUN较术前降低(P<0.05);随访期间发生再出血3例,发生率为9.38%(3/32);发生肝性脑病5例,发生率为15.63%(5/32);发生分流道狭窄6例,发生率为18.75%(6/32)。结论 TIPS术中使用Viatorr支架治疗肝硬化PHT伴UGB,可显著降低患者术后门静脉压,临床疗效显著,且患者术后再出血、肝性脑病及分流道狭窄发生风险低。

关键词: 肝硬化门静脉高压, 上消化道出血, 经颈静脉肝内门腔静脉分流术, Viatorr支架, 肝功能

Abstract: Objective To observe the clinical efficacy and safety of Viatorr stent during transjugular intrahepatic portosystemic shunt (TIPS) in patients with cirrhotic portal hypertension (PHT) with upper gastrointestinal bleeding (UGB).Methods 32 patients with cirrhotic PHT and UGB treated in the hospital from November 2017 to December 2020 were selected as the research subjects, all patients were treated with Viatorr stent during TIPS and followed up in the clinic; the success rate of Viatorr stent implantation of patients was observed. The preoperative and postoperative portal vein pressure indexes [portal vein pressure gradient (PPG), portal vein pressure (PVP), portal vein velocity (PVV)] of patients were compared, changes of blood routine indexes [platelet count (PLT), hemoglobin (Hb), leukocyte count (WBC)], liver and kidney function indexes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), Albumin (Alb), total bilirubin (TBil), serum creatinine (Scr), urea nitrogen (BUN)] and coagulation function indexes [prothrombin time (PT)] were observed before operation, 1 week, 1 month and 6 months after operation. The incidence of adverse events such as rebleeding, hepatic encephalopathy and shunt stenosis of patients within 6 months after operation were counted.Results 32 patients with PHT and UGB were successfully implanted with Viatorr stent, and the success rate was 100% (32/32); 3 days after operation, PVV and PVP were (51.28 ± 10.46) cm/s and (2.17 ± 0.63) mmHg, respectively, higher than those before operation (29.78 ± 7.65) cm/s and (3.32 ± 0.84) mmHg, and PPG was (12.75 ± 4.13) mmHg, lower than that before operation (21.46 ± 6.28) mmHg (P<0.05); from 1 week to 6 months after operation, the levels of PLT, Hb and WBC pf patients were gradually increased than those before operation (P<0.05); 1 week after operation, ALT, AST, TBil and PT of patients were increased and Alb was decreased than those before operation. 1 and 6 months after operation, ALT, AST, TBil and PT were gradually decreased, Alb was gradually increased (P<0.05); at 1 week, 1 month and 6 months after operation, Scr and BUN were significantly decreased than those before operation (P<0.05); during follow-up period, rebleeding occurred in 3 cases, with an incidence of 9.38% (3/32); and hepatic encephalopathy in 5 cases, with an incidence of 15.63% (5/32); shunt stenosis occurred in 6 cases, with an incidence of 18.75% (6/32).Conclusion The use of Viatorr stent in TIPS in the treatment of cirrhotic PHT with UGB can significantly reduce the postoperative portal venous pressure of patients, while the clinical effect is significant, and the risk of postoperative rebleeding, hepatic encephalopathy and shunt stenosis of patients is low.

Key words: Cirrhotic portal hypertension, Upper gastrointestinal bleeding, Transjugular intrahepatic portosystemic shunt, Viatorr stent, Liver function

杨美蓉, 陈卫, 邓俊, 孙俊凯, 周颜, 蒋骏麟, 李书书. Viatorr支架TIPS术治疗肝硬化门静脉高压伴上消化道出血的效果分析[J]. 肝脏, 2022, 27(11): 1189-1193.

YANG Mei-rong, CHEN Wei, DENG Jun, SUN Jun-kai, ZHOU Yan, JIANG Jun-lin, LI Shu-shu. Analysis of Viatorr stent in the treatment of cirrhotic portal hypertension with upper gastrointestinal bleeding during TIPS[J]. Chinese Hepatolgy, 2022, 27(11): 1189-1193.

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