Postoperative shunt restenosis of transjugular intrahepatic portasystemic shunt using covered stent in patients with portal hypertension and analysis of its influencing factors
10.3760/cma.j.issn.1673-4904.2014.19.014
- VernacularTitle:门静脉高压症经颈静脉肝内门体分流术后覆膜支架分流道再狭窄率及原因分析
- Author:
Heng ZHANG
;
Yongli ZHANG
- Publication Type:Journal Article
- Keywords:
Hypertension,portal;
Portasystemic shunt,transjugular intrahepatic;
Covered stent;
Restenosis
- From:
Chinese Journal of Postgraduates of Medicine
2014;37(19):39-42
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the postoperative shunt restenosis of transjugular intrahepatic portasystemic shunt (TIPS) using polytetrafluoroethyoethylene (PTFE) covered stent in patients with portal hypertension,and discuss its influencing factors.Methods The clinical data of 82 patients with portal hypertension were retrospectively analyzed.TIPS with PTFE covered stent was carried out in all patients,and the preoperative Child-Pugh score was (6.74 ± 1.05) scores.The patients were followed up for 12-55 (24.9 ± 10.4) months.Single and multiple factor analysis using Cox regression were performed to evaluate the influencing factors.Results Under the local anaesthesia,TIPS was successful performed in all 82 patients.The portosystemic pressure gradient decreased from preoperative (27.46 ±4.08) mmHg (1 mmHg =0.133 kPa) to postoperative (15.71 ±2.07) mmHg,and the difference was statistically significant (t =1.804,P < 0.01).The Child-Pugh score 3 months after operation was (6.57 ± 1.43) scores,and there was no statistical difference compared with that before treatment (t =12.931,P> 0.05).During the follow-up period,shunt restenosis of covered stent occurred in 8 patients,and the rate of restenosis was 9.8% (8/82).Cox single analysis showed that the covered stent length within portal vein 1.0 cm and its location in hepatic vein had statistical significance,and multiple factor regression analysis showed that the covered stent location in hepatic vein was the independent influencing factor of shunt restenosis (OR =26.647,95% CI:8.257-20.061,P =0.005).Conclusions TIPS with PTFE covered stent can markedly increase the shunt patency rate.A proper location of the covered stent within hepatic vein carries lower restenosis incidence.Hyperextension of the stent into portal vein is not recommended.