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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(P<0.001)。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(P<0.001)。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。
Objective To investigate the causes of loss of function of transjugular intrahepatic portosystemic shunt (TIPS) with elasticized straight stent-graft. Methods A retrospective analysis was performed on 31 patients undergoing interventional shunt repair between January 2008 and December 2015. According to DSA imaging data of two interventional procedures, 31 patients were divided into four groups: group A (n = 16), group B (n = 15) and group B (group B). Thirty-seven TIPS patients were followed up for more than 2 years with shunt patency as control group (C group). The clinical data of the patients in each group were compared and analyzed. The included angles between the hepatic venous end, the portal vein end and the hepatic parenchyma were measured as α and β angles, and the coverage of the hepatic veins in each group was observed. Results The duration of patency in group A was (18.9 ± 14.6) months, in group B was 4.0 ± 4.8 months, and in group C was (30.6 ± 5.9) months, the difference was statistically significant (P < 0.001). The gender, age, TIPS indications, and the causes of cirrhosis among the groups were not statistically significant. There was no significant difference in α angle between groups. The β angle was 167.2 ° ± 8.9 ° in group A, 164.5 ° ± 21.3 ° in group B, and 175.5 ° ± 8.1 ° in group C. The difference was statistically significant (P = 0.007). A group of 44% covered the stent to the hepatic vein opening, 67% of the stent covered the hepatic vein in Group B, and 92% covered the hepatic vein in Group C, the difference was statistically significant (P <0.001). Logistic regression analysis showed that the beta angle (OR = 0.929, P = 0.010) and the coverage of the stent graft to the hepatic venous opening (OR = 0.100, P = 0.002) were associated with loss of TIPS shunt function. Conclusion The elastic straightening of stent-graft is the main factor in the long-term shunt loss of function after TIPS. Overlapped at the portal vein end of the stent-graft, and the length of the hepatic veins in the stent-graft is too short, which is an important reason for the loss of flexibility of the stent-graft to the straight component flow channel.