彩色多普勒超声探讨裸支架与膨体-聚四氟乙烯覆膜支架对T...

聚四氟乙烯

彩色多普勒超声探讨裸支架与膨体-聚四氟乙烯覆膜支架对TIPS血流动力学和疗效的影响
范欣鑫 吴性江 黄骞 徐琳南京军区总医院普通外科,南京市210002

摘　要:目的对比研究裸支架与膨体-聚四氟乙烯（ePTFE）覆膜支架对肝硬化门脉高压症患者经颈静脉肝内门体分流（TIPS）术后血流动力学和临床疗效的影响。方法对60例门脉高压症患者行TIPS术，术中分别应用8mm直径裸支架及ePTFE覆膜支架。术后观察临床疗效，并应用彩色多普勒超声（color Doppler ultrasound，CDU）技术监测手术前后及随访过程中门脉系及肝动脉血流动力学变化。结果所有患者均顺利完成TIPS术，术中未出现并发症。术后平均随访12．5个月（3～15个月）。覆膜支架组初次开通率100％，裸支架组初次开通率73％。超声多普勒显示TIPS术后及随访中覆膜支架组门静脉系统血流速度、流量参数均显著高于裸支架组，覆膜支架组随访1年分流道流速及流量参数高于裸支架组[（125±20）VS（65±13）cm／s，（1816±380）VS（744±239）ml／min，P〈0．01]，覆膜支架组随访1年肝动脉血流速度高于裸支架组[（60±14）VS（52±13）cm／s]。结论ePTFE覆膜支架在TIPS中的应用，显著提高了肝内分流道的远期通畅率和临床疗效，超声多普勒显示门静脉系统及肝动脉血流动力学参数显著升高。肝动脉缓冲效应在TIPS术后维持肝血流量稳定中发挥了重要的代偿作用。[著者文摘]

关键词:经颈静脉肝内门体分流 覆膜支架 超声多普勒 血流动力学
分类号:　R774.6[机标]文献标识码：文章编号：栏目信息：临床研究
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Influence of Bare Stents Versus EPTFE-covered Stents on Hemodynamics and Clinic Outcome for Transjugular Intrahepatic Portosystemic Shunts Using Color Doppler Ultrasound TechniqueFan Xinxin, Wu Xingjiang, Huang Qian, et al Surgery Department, General Hospital of Nanjing, Chinese People＇s Liberation Army, Nanjing 210002 ChinaAbstract:Objective To evaluate hemodynamics and clinic outcome using bare stents versus ePTFE-covered stents for transjugular intrahepatic portosystemic shunts（TIPS） in patients with portal hypertension by color Doppler ultrasound. Methods Sixty patients with portal hypertension underwent TIPS with 8mm diameter bare stents and ePTFE-covered stent. The clinic outcome was observed after TIPS, and the hemodynamics of portal vein system and hepatic artery were studied before and after TIPS and during the follow up using color Doppler ultrasound technique. Results TIPS were successfully carried out in all patients without related complications. Median follow-up was 12.5 months （ranged 3 to 15 months）. The primary patency rate was 100% in covered stents group, and the primary patency rate was 73% in bare stents group. The blood velocity and volume of venous return of portal vein system were significantly higher in covered stents group than in bare stents group after TIPS and during the follow-up using color Doppler ultrasound method. The blood velocity and volume of the shunts were significantly higher in covered stents group than in bare stents group after 1 year （125±20 vs 65±13,1816±380 vs 744±239,P〈0.01）. The blood velocities of hepatic artery were significantly higher in covered stents group than in bare stents group after 1 year （60±14 vs 52±13）. Conclusions The Application of ePTFE-covered stents in TIPS has significantly improved the long term shunt patency and clinic efficacy. The hemodynamics index of portal vein system and hepatic artery significantly increased by color Doppler ultrasound. Hepatic arterial buffer response plays vital role in maintaining stability of hepatic blood volume after TIPS.[著者文摘]

Key words:Transjugular intrahepatic portosystemic shunts, Expanded-polytetrafluoroethylene covered stents, Color Doppler ultrasound, Hemodynamics.