采用覆膜支架行经颈静脉肝内门腔分流术的相关研究
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摘要
背景
经颈静脉肝内门腔分流术(Transjugular intrahepatic portosystemic shunt, TIPS)现已广泛应用于门静脉高压症的治疗。但其最主要的缺点即为术后分流道的再狭窄或闭塞率较高,据统计术后一年的再狭窄率高达30-70%。为解决术后再狭窄的的问题,近年来研究已证实相比于既往使用的裸支架,聚四氟乙烯(PTFE)覆膜支架(Viatorr支架,GORE公司,美国)能明显降低TIPS术后再狭窄的发生。2009年,美国肝脏病学会(AASLD)为此修订门脉高压症的治疗指南,明确建议采用覆膜支架完成TIPS。
遗憾的是Viatorr支架至今仍未进入中国市场,于是我们采用Fluency覆膜支架(Bard公司,美国)来建立TIPS分流道。Fluency支架的覆膜材料与Viatorr支架相同,均为PTFE,而且内层的碳涂层能进一步减少血小板聚集,提高通畅率。但与Viatorr支架前端的2cm裸区不同,Fluency支架为全程覆膜,有必要对其操作安全可行性,临床疗效及影响因素进行重新认识及分析。
目的
探讨采用聚四氟四烯(PTFE)覆膜支架(Fluency支架,Bard公司)完成经颈静脉肝内门腔分流术(transjugular intrhepatic portosystemic shunt, TIPS)的技术方法,评价其在肝硬化门脉高压症患者治疗中的临床疗效及影响因素分析,初步探讨在门脉主干癌栓患者中的使用经验。
材料与方法
1、覆膜支架TIPS的临床疗效及相关危险因素分析。
从2005年10月至2011年7月,对102例门脉高压症患者行覆膜支架TIPS术,其中男性82例,女性20例,年龄16～73岁(52.6±12.6岁)。在门静脉高压症的病因中,82例为慢性乙型病毒性肝炎后肝硬化,8例酒精性肝硬化,5例Budd-Chiarri综合征,4例慢性丙型病毒性肝炎后肝硬化,还有3例为其他原因所致的门静脉高压症。术前症状均为食管胃底静脉曲张大出血(83例)或顽固性腹水(19例),术前肝功Child-Pugh评分为5-10分(平均6.65±1.66),分级A级52例,B级41例,C级9例。全部患者均采用覆膜支架行TIPS术。随访终点截止在2012年1月,采用寿命表法绘制术后6,12,24,36,48月的分流道开通率,术后生存率,术后HE的发生率曲线,采用Cox回归分析对其影响因素进行单因素及多因素分析。
2、覆膜支架TIPS在门脉主干癌栓患者中的应用探讨
5例原发性肝癌伴门脉主干癌栓导致门脉高压症患者,其中3例表现为食管胃底静脉曲张伴急性上消化道大出血,另2例为顽固性腹水。均行TIPS术,术中采用Fluency覆膜支架建立肝内门腔分流道。测量支架置入前后的门脉压力,术后随访2-12个月,分析临床效果。
结果
1、覆膜支架TIPS的临床疗效及相关危险因素分析。
全部102例均在局麻下成功建立肝内门腔覆膜支架分流道,技术成功率100%,共置入支架128枚,支架直径6-10mm(8.05±0.9mm)。其中覆膜支架104枚,裸支架24枚。有3例患者出现围手术期并发症,其中2例腹腔出血,1例支架周围感染。截止2012年1月,全部102例患者随访时间为0～58月(19.9±13.3月)。有42例出现终点事件,其中10例出现术后分流道再狭窄(9.8%),16例死亡(15.7%),3例转肝脏移植(2.9%),7例进展为原发性肝癌(6.9%),6例失访(5.9%)。余60例则随访至截止点(58.8%)。
术前门脉压力为21-56cmH20(38.1±6.9cmH20),术后门脉压力为10-48cmH20(23.7±6.1cmH20),下降明显(配对t检验,t=22.8,P<0.01)。术前肝功Child-pugh评分为6.65±1.66,有2例患者在术后3月内死亡,故有100例在术后3月时复查肝功,评分为6.46±1.55,行t检验无显著差异(t=0.829,P=0.408)。
102例患者中,在随访期间确诊出现覆膜支架分流道术后再狭窄的共10例,总体一期再狭窄率为9.8%。采用寿命表法绘制随访期间覆膜支架分流道一期通畅率,结果显示术后6,12,24,36,48月的累积通畅率分别是96%,91%,82%,82%,82%。Cox单因素及多因素分析结果示支架肝静脉端位置评价为独立影响因素(P=.000,OR=27.758)。
102例患者中,在随访期间确诊出现肝性脑病(HE)的病例共27例,发生率为26.5%。采用寿命表法绘制随访期间HE的累积发生率,结果显示术后6,12,24,36,48月的术后HE累积发生率分别是7%,21%,34%,46%,66%。Cox单因素及多因素分析结果示术前肝功Child-pugh分级(P=.000)和支架术后门脉显影情况(P=.007)为显著影响因素。
102例患者在随访期间,有16例发生死亡,总体死亡率为15.7%。采用寿命表法绘制随访期间生存率,结果显示术后6,12,24,36,48月的累积生存率分别是95%,83%,76%,76%,76%。Cox单因素及多因素分析结果示术前肝功Child-pugh分级(P=.001)和术前门脉压力(P-.011)为显著影响因素。
2、覆膜支架TIPS在门脉主干癌栓患者中的应用探讨
5例患者TIPS手术全部成功,共置入9枚覆膜支架,直径8mm支架8枚,7mm支架1枚,支架长度6-8cm。术前门脉-右房压力差(PSG)平均37.8mmHg(33-45mmHg),术后下降为12.0mmHg(7-20mmHg)。2例在术后1周出现一过性记忆力减退,经口服乳果糖等内科处理后消失。3例急性上消化道大出血患者术后出血停止,另2例顽固性腹水患者术后腹水明显减轻。随访期间,超声提示支架血流通畅,症状无复发。2例于术后2月,2例术后4月死亡,死因为多器官功能衰竭,1例随访12月仍存活。
结论
1、采用覆膜支架行TIPS术在技术上安全可行。
2、覆膜支架可以明显提高TIPS术后分流道通畅率,同时并没有增加术后HE的发生率,且有改善生存率的趋势。
3、支架肝静脉端位置欠佳是覆膜支架TIPS术后分流道再狭窄的独立影响因素,同时不建议覆膜支架门脉端伸入过长。
4、术前肝功Child-pugh分级和术后门脉显影情况为覆膜支架TIPS术后的HE发生的显著影响因素。术前肝功Child-pugh分级越差,术后门脉分支均不显影的患者术后HE的发生率明显升高。
5、术前肝功Child-pugh分级和术前门脉压力为覆膜支架TIPS术后生存率的显著影响因素。术前肝功Child-pugh分级越差,术前门脉压力越高的患者,术后生存率越差。
6、对于门脉主干癌栓并门脉高压症患者,采用覆膜支架行TIPS术是可行的,可有效控制近期内的门脉高压相关症状。
Background
Transjugular intrahepatic portosystemic shunts (TIPS) have been increasingly used for the treatment of complications of portal hypertension in patients with cirrhosis. However, one of the main drawbacks is the high rate of shunt dysfunction, reported in30-70%within the first year. Recently, the use of a new generation of polytetrafluoroethyoethylene covered stent stent (Viatorr stent, GORE, Flagstaff, AZ, USA) overcame the problem of shunt dysfunction with significant improvement in TIPS patency and clinical efficacy. In the2009practice guidelines about TIPS by the American Association for the Study of Liver Diseases (AASLD), use of expanded PTFE-covered stents is now preferred.
Unfortunately, the most common used Viatorr stent is not commercially available in our country. So we choose Fluency stent (Bard Inc, Germany) istead of Viatorr stent to complete TIPS. Fluency stent is all covered (except2mm bare segment) and the cover material is the same as Viatorr stent-graft with PTFE, in addition to this, the carbon impregnation technology applied in inner surface of Fluency stent can decrease platelet accumulation, which can also reduce the incidence of restenosis. Reunderstanding th safety and feasibility of Fluency stent should be of value to promote the development of TIPS.
Purpose
The purpose of this study are to desceribe the results of a prospective trial on the technical improvement of transjugular intrahepatic portosystemic shunts (TIPS) using polytetrafluoroethyoethylene covered stent (Fluency covered stent. Bard Corp), and to evaluate the clinical application of covered stent TIPS for the treatment of portal hypertention.
Materials and Methods
1. To evaluate the clinical effect of TIPS with covered stent and analyze the affected factors
From Oct,2005to Jul,2011,102patients (82men and20women; mean age:52.6) with portal hypertension according to liver cirrhosis underwent TIPS with covered-stent. The causes of liver cirrhosis were hepatitis B (n=82), alcohol abuse (n=8), Budd-Chiari syndrome (n=5), hepatitis C (n=4) and cryptogenic cause (n=3). Indications for treatment were variceal bleeding (n=83), refractory ascites (n=19). Fifty-five patients had Child-Pugh class A cirrhosis;41had Child-Pugh Class B; and9, Child-Pugh class C. All patients underwent clinical follow-up at3,6,12,24,36,48months after TIPS and the end-point was Jan,2011. Cumulative patency of shunt with covered stent, hepatic encephalopathy (HE) and survial rates were calculated with the life-talble method, Stepwise multiple Cox regression analyses wre performed to assess factors influencing shunt malfunction and HE rate and mortality.
2. To discuss the clinical application of TIPS with covered stent in the treatment of portal hypertension accompanying main portal vein tumor thrombus (MPVTT).
A cohort of5patients with portal hypertension due to primary liver cancer complicated by portal vein thrombosis were selected,3having clinical manifestations of esophagogastric varicosis and acute massive upper gastrointestinal bleeding, the other2having refractory ascites. All the patients received TIPS with Fluency covered stent. Portal pressures before and after the stent implantation were measured. All the patients were followed up2to12months to analyze their therapeutic outcomes.
Results
1. To evaluate the clinical effect of TIPS with covered stent and analyze the affected factors
The procedure was successful in all102patietns. The mean portosystemic pressure of portal vein decreased from38.1cmH20to23.7cmH20(paired t, p<0.01). Three TIPS-related complications occurred (two cases of serious hemopertoneum and one infection arround covered-stent). Forty-two patients reached the end-point before Jan,2012, including shunt restenosis (n=10,9.8%), death according to different causes (n=16,15.7%), orthotopic liver transplantation (n=3,2.9%), primary hepatocellular carcinoma (n=7,6.9%) and lost, six (5.9%). During the follow-up, shunt restenosis occurred in10patients (9.8%), Cumulative primary patency rates were96%,91%,82%,82%and82%at6,12,24,36and48months, respectively. The hepatic vein location of stent was independent affect fator of shunt restenosis (P=0.000). postprocedural HE occurred in27patients (26.5%), Cumulative HE rates were7%,21%,34%,46%and66%at6,12,24,36and48months, respectively. The affect fator of HE rates included Child-pugh class before TIPS and potal vein post cover-stent implanted(p=0.000,0.007, respectively). The overall mortality rare was15.7%(n=16), Cumulative survial rates were95%,83%,76%,76%and76%at6,12,24,36and48months, respectively. The affect factors of survial rates included Child-pugh class and pressure of potal vein before TIPS (P=0.001,0.011, respectively).
2. To discuss the clinical application of TIPS with covered stent in the treatment of portal hypertension accompanying main portal vein tumor thrombus (MPVTT).
TIPS was successfully performed in all the5patients, with9covered stents implanted including8with a diameter of8mm and1with a diameter of7mm. The length of implanted stents ranged from6to8cm. The preoperative mean pressure difference between portal vein and right atrium (PSG),37.8mmHg (33-45mmHg), decreased to12.0mmHg (7-20mmHg) after the procedure. Two cases had a transient memory loss at1week after the surgery that was cured by giving oral lactulose as well as other medications. All the3cases with acute massive upper gastrointestinal bleeding were cured with hemostasis after the surgery, and refractory ascites of the other2patients was obviously alleviated. During the follow-up, ultrasound indicated smooth blood flow through the stent and there was no recurrence of symptoms. Death occurred2months after the procedure in2cases and4months after the procedure in another2cases, with all due to multiple organs failure, and the other1patient survived the12months follow-up.
Conclusions
The Fluency covered stent is safe and effective in TIPS, with clear improvement of shunt patency, without increasing the risk of hepatic encephalopathy and with a trend towards better survival.
TIPS with Fluency covered stent is feasible for patients with portal hypertension accompanying main portal vein tumor thrombus. The procedure can effectively control the short-term symptoms related to portal hypertension.
经颈静脉肝内门腔分流术(Transjugular intrahepatic portosystemic shunt, TIPS)现已广泛应用于门静脉高压症的治疗。但其最主要的缺点即为术后分流道的再狭窄或闭塞率较高,据统计术后一年的再狭窄率高达30-70%。为解决术后再狭窄的的问题,近年来研究已证实相比于既往使用的裸支架,聚四氟乙烯(PTFE)覆膜支架(Viatorr支架,GORE公司,美国)能明显降低TIPS术后再狭窄的发生。2009年,美国肝脏病学会(AASLD)为此修订门脉高压症的治疗指南,明确建议采用覆膜支架完成TIPS。
遗憾的是Viatorr支架至今仍未进入中国市场,于是我们采用Fluency覆膜支架(Bard公司,美国)来建立TIPS分流道。Fluency支架的覆膜材料与Viatorr支架相同,均为PTFE,而且内层的碳涂层能进一步减少血小板聚集,提高通畅率。但与Viatorr支架前端的2cm裸区不同,Fluency支架为全程覆膜,有必要对其操作安全可行性,临床疗效及影响因素进行重新认识及分析。
目的
探讨采用聚四氟四烯(PTFE)覆膜支架(Fluency支架,Bard公司)完成经颈静脉肝内门腔分流术(transjugular intrhepatic portosystemic shunt, TIPS)的技术方法,评价其在肝硬化门脉高压症患者治疗中的临床疗效及影响因素分析,初步探讨在门脉主干癌栓患者中的使用经验。
材料与方法
1、覆膜支架TIPS的临床疗效及相关危险因素分析。
从2005年10月至2011年7月,对102例门脉高压症患者行覆膜支架TIPS术,其中男性82例,女性20例,年龄16～73岁(52.6±12.6岁)。在门静脉高压症的病因中,82例为慢性乙型病毒性肝炎后肝硬化,8例酒精性肝硬化,5例Budd-Chiarri综合征,4例慢性丙型病毒性肝炎后肝硬化,还有3例为其他原因所致的门静脉高压症。术前症状均为食管胃底静脉曲张大出血(83例)或顽固性腹水(19例),术前肝功Child-Pugh评分为5-10分(平均6.65±1.66),分级A级52例,B级41例,C级9例。全部患者均采用覆膜支架行TIPS术。随访终点截止在2012年1月,采用寿命表法绘制术后6,12,24,36,48月的分流道开通率,术后生存率,术后HE的发生率曲线,采用Cox回归分析对其影响因素进行单因素及多因素分析。
2、覆膜支架TIPS在门脉主干癌栓患者中的应用探讨
5例原发性肝癌伴门脉主干癌栓导致门脉高压症患者,其中3例表现为食管胃底静脉曲张伴急性上消化道大出血,另2例为顽固性腹水。均行TIPS术,术中采用Fluency覆膜支架建立肝内门腔分流道。测量支架置入前后的门脉压力,术后随访2-12个月,分析临床效果。
结果
1、覆膜支架TIPS的临床疗效及相关危险因素分析。
全部102例均在局麻下成功建立肝内门腔覆膜支架分流道,技术成功率100%,共置入支架128枚,支架直径6-10mm(8.05±0.9mm)。其中覆膜支架104枚,裸支架24枚。有3例患者出现围手术期并发症,其中2例腹腔出血,1例支架周围感染。截止2012年1月,全部102例患者随访时间为0～58月(19.9±13.3月)。有42例出现终点事件,其中10例出现术后分流道再狭窄(9.8%),16例死亡(15.7%),3例转肝脏移植(2.9%),7例进展为原发性肝癌(6.9%),6例失访(5.9%)。余60例则随访至截止点(58.8%)。
术前门脉压力为21-56cmH20(38.1±6.9cmH20),术后门脉压力为10-48cmH20(23.7±6.1cmH20),下降明显(配对t检验,t=22.8,P<0.01)。术前肝功Child-pugh评分为6.65±1.66,有2例患者在术后3月内死亡,故有100例在术后3月时复查肝功,评分为6.46±1.55,行t检验无显著差异(t=0.829,P=0.408)。
102例患者中,在随访期间确诊出现覆膜支架分流道术后再狭窄的共10例,总体一期再狭窄率为9.8%。采用寿命表法绘制随访期间覆膜支架分流道一期通畅率,结果显示术后6,12,24,36,48月的累积通畅率分别是96%,91%,82%,82%,82%。Cox单因素及多因素分析结果示支架肝静脉端位置评价为独立影响因素(P=.000,OR=27.758)。
102例患者中,在随访期间确诊出现肝性脑病(HE)的病例共27例,发生率为26.5%。采用寿命表法绘制随访期间HE的累积发生率,结果显示术后6,12,24,36,48月的术后HE累积发生率分别是7%,21%,34%,46%,66%。Cox单因素及多因素分析结果示术前肝功Child-pugh分级(P=.000)和支架术后门脉显影情况(P=.007)为显著影响因素。
102例患者在随访期间,有16例发生死亡,总体死亡率为15.7%。采用寿命表法绘制随访期间生存率,结果显示术后6,12,24,36,48月的累积生存率分别是95%,83%,76%,76%,76%。Cox单因素及多因素分析结果示术前肝功Child-pugh分级(P=.001)和术前门脉压力(P-.011)为显著影响因素。
2、覆膜支架TIPS在门脉主干癌栓患者中的应用探讨
5例患者TIPS手术全部成功,共置入9枚覆膜支架,直径8mm支架8枚,7mm支架1枚,支架长度6-8cm。术前门脉-右房压力差(PSG)平均37.8mmHg(33-45mmHg),术后下降为12.0mmHg(7-20mmHg)。2例在术后1周出现一过性记忆力减退,经口服乳果糖等内科处理后消失。3例急性上消化道大出血患者术后出血停止,另2例顽固性腹水患者术后腹水明显减轻。随访期间,超声提示支架血流通畅,症状无复发。2例于术后2月,2例术后4月死亡,死因为多器官功能衰竭,1例随访12月仍存活。
结论
1、采用覆膜支架行TIPS术在技术上安全可行。
2、覆膜支架可以明显提高TIPS术后分流道通畅率,同时并没有增加术后HE的发生率,且有改善生存率的趋势。
3、支架肝静脉端位置欠佳是覆膜支架TIPS术后分流道再狭窄的独立影响因素,同时不建议覆膜支架门脉端伸入过长。
4、术前肝功Child-pugh分级和术后门脉显影情况为覆膜支架TIPS术后的HE发生的显著影响因素。术前肝功Child-pugh分级越差,术后门脉分支均不显影的患者术后HE的发生率明显升高。
5、术前肝功Child-pugh分级和术前门脉压力为覆膜支架TIPS术后生存率的显著影响因素。术前肝功Child-pugh分级越差,术前门脉压力越高的患者,术后生存率越差。
6、对于门脉主干癌栓并门脉高压症患者,采用覆膜支架行TIPS术是可行的,可有效控制近期内的门脉高压相关症状。
Background
Transjugular intrahepatic portosystemic shunts (TIPS) have been increasingly used for the treatment of complications of portal hypertension in patients with cirrhosis. However, one of the main drawbacks is the high rate of shunt dysfunction, reported in30-70%within the first year. Recently, the use of a new generation of polytetrafluoroethyoethylene covered stent stent (Viatorr stent, GORE, Flagstaff, AZ, USA) overcame the problem of shunt dysfunction with significant improvement in TIPS patency and clinical efficacy. In the2009practice guidelines about TIPS by the American Association for the Study of Liver Diseases (AASLD), use of expanded PTFE-covered stents is now preferred.
Unfortunately, the most common used Viatorr stent is not commercially available in our country. So we choose Fluency stent (Bard Inc, Germany) istead of Viatorr stent to complete TIPS. Fluency stent is all covered (except2mm bare segment) and the cover material is the same as Viatorr stent-graft with PTFE, in addition to this, the carbon impregnation technology applied in inner surface of Fluency stent can decrease platelet accumulation, which can also reduce the incidence of restenosis. Reunderstanding th safety and feasibility of Fluency stent should be of value to promote the development of TIPS.
Purpose
The purpose of this study are to desceribe the results of a prospective trial on the technical improvement of transjugular intrahepatic portosystemic shunts (TIPS) using polytetrafluoroethyoethylene covered stent (Fluency covered stent. Bard Corp), and to evaluate the clinical application of covered stent TIPS for the treatment of portal hypertention.
Materials and Methods
1. To evaluate the clinical effect of TIPS with covered stent and analyze the affected factors
From Oct,2005to Jul,2011,102patients (82men and20women; mean age:52.6) with portal hypertension according to liver cirrhosis underwent TIPS with covered-stent. The causes of liver cirrhosis were hepatitis B (n=82), alcohol abuse (n=8), Budd-Chiari syndrome (n=5), hepatitis C (n=4) and cryptogenic cause (n=3). Indications for treatment were variceal bleeding (n=83), refractory ascites (n=19). Fifty-five patients had Child-Pugh class A cirrhosis;41had Child-Pugh Class B; and9, Child-Pugh class C. All patients underwent clinical follow-up at3,6,12,24,36,48months after TIPS and the end-point was Jan,2011. Cumulative patency of shunt with covered stent, hepatic encephalopathy (HE) and survial rates were calculated with the life-talble method, Stepwise multiple Cox regression analyses wre performed to assess factors influencing shunt malfunction and HE rate and mortality.
2. To discuss the clinical application of TIPS with covered stent in the treatment of portal hypertension accompanying main portal vein tumor thrombus (MPVTT).
A cohort of5patients with portal hypertension due to primary liver cancer complicated by portal vein thrombosis were selected,3having clinical manifestations of esophagogastric varicosis and acute massive upper gastrointestinal bleeding, the other2having refractory ascites. All the patients received TIPS with Fluency covered stent. Portal pressures before and after the stent implantation were measured. All the patients were followed up2to12months to analyze their therapeutic outcomes.
Results
1. To evaluate the clinical effect of TIPS with covered stent and analyze the affected factors
The procedure was successful in all102patietns. The mean portosystemic pressure of portal vein decreased from38.1cmH20to23.7cmH20(paired t, p<0.01). Three TIPS-related complications occurred (two cases of serious hemopertoneum and one infection arround covered-stent). Forty-two patients reached the end-point before Jan,2012, including shunt restenosis (n=10,9.8%), death according to different causes (n=16,15.7%), orthotopic liver transplantation (n=3,2.9%), primary hepatocellular carcinoma (n=7,6.9%) and lost, six (5.9%). During the follow-up, shunt restenosis occurred in10patients (9.8%), Cumulative primary patency rates were96%,91%,82%,82%and82%at6,12,24,36and48months, respectively. The hepatic vein location of stent was independent affect fator of shunt restenosis (P=0.000). postprocedural HE occurred in27patients (26.5%), Cumulative HE rates were7%,21%,34%,46%and66%at6,12,24,36and48months, respectively. The affect fator of HE rates included Child-pugh class before TIPS and potal vein post cover-stent implanted(p=0.000,0.007, respectively). The overall mortality rare was15.7%(n=16), Cumulative survial rates were95%,83%,76%,76%and76%at6,12,24,36and48months, respectively. The affect factors of survial rates included Child-pugh class and pressure of potal vein before TIPS (P=0.001,0.011, respectively).
2. To discuss the clinical application of TIPS with covered stent in the treatment of portal hypertension accompanying main portal vein tumor thrombus (MPVTT).
TIPS was successfully performed in all the5patients, with9covered stents implanted including8with a diameter of8mm and1with a diameter of7mm. The length of implanted stents ranged from6to8cm. The preoperative mean pressure difference between portal vein and right atrium (PSG),37.8mmHg (33-45mmHg), decreased to12.0mmHg (7-20mmHg) after the procedure. Two cases had a transient memory loss at1week after the surgery that was cured by giving oral lactulose as well as other medications. All the3cases with acute massive upper gastrointestinal bleeding were cured with hemostasis after the surgery, and refractory ascites of the other2patients was obviously alleviated. During the follow-up, ultrasound indicated smooth blood flow through the stent and there was no recurrence of symptoms. Death occurred2months after the procedure in2cases and4months after the procedure in another2cases, with all due to multiple organs failure, and the other1patient survived the12months follow-up.
Conclusions
The Fluency covered stent is safe and effective in TIPS, with clear improvement of shunt patency, without increasing the risk of hepatic encephalopathy and with a trend towards better survival.
TIPS with Fluency covered stent is feasible for patients with portal hypertension accompanying main portal vein tumor thrombus. The procedure can effectively control the short-term symptoms related to portal hypertension.
引文
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[9]Laberge JM, Somberg KA, Lake JR, et al. Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding:results in 90 patients. Gastroenterology 1995;108(4):1143-51
[10]Haskal ZJ, Pentecost MJ, Soulen MC, et al. Transjugular intrahepatic portosystemic Shunt stenosis and revision:early and midterm results. Am J Roentgenol 1994; 163:439-44
[11]Saxon RR, Ross PL, Mendel-Hartvig J, et al. Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. Radiology 1998;207:683-93
[12]Sterling KM, Darcy MD. Stenosis of Transjugular intrahepatic portosystemic shunts:Presentation and management. Am J Roentgenol 1997; 168:239-44
[13]Nazarian GK, Ferral H, Castaneda-Zuniga WR, et al. Development of stenosis in Transjugular intrahepatic portosystemic shunts. Radiology 1994; 192:231-4
[14]Latimer J, Bawa SM, Rees CJ, et al. Patency and reintervention rates during routine TPSS surveillance, Cardiovasc Interv Radiol 1998:21:234-9
[15]Saxon RR, Mendel-Hartvig J, Corless CL. et al. Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts: Comparative histopathologic analysis in humans and swine. J Vase Interv Radiol 1996; 7:487-97
[16]Jalan R, Harrison DJ, Redhead DN. et al. transjugular intrahepatic portosystemic shunt (TIPSS) occlusion and the role of biliary venous fistulae. J Hepatol 1996;24; 169-76.
[17]Ducoin H, EL-Khoury J, Rousseau H. et al. Histopathologic analysis of transjugular intrahepatic portosystemic shunt. Hepatology 1997;23:1064-9
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[20]Otal P, Rousseau H, Vinel JP, et al. High occlusion rate in experimental transjugular intrahepatic portosystemic shunt created with a Dacron-covered nitionol stent. J Vasc Interv Radiol 1999; 10:183-6
[21]Nishimine K, Saxon RR, Kichikawa K, et al. Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts:experimental results in swne. Radiology 1995;196:341-7
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[1]Rossle M, Haag K, Ochs A, et al. The transjugular intrahepatic portosystemic stent-shunt procedure for variceal bleeding. N Engl J Med 1994;330:165-71
[2]Cabrera J, Maynar M, Granados R, et al. Transjugular intrahepatic portosystemic shunt versus sclerotheraphy in the elective treatment of variceal hemorrhage. Gastroenterology 1996;110:832-9
[3]Sanjal AJ, Freedman AM, Luketic VA, et al. Transjugular intrahepatic portosystemic shunts for patients with active variceal hemorrhage unresponsive to sclerotheraphy. Gastroenterology 1996; 111:138-46
[4]Sauer P, Theilman L, Stremmer W, et al. Transjugular intrahepatic portosystemic stent shunt versus sclerotheraphy plus propanolol for variceal rebleeding. Gastroenterology 1997; 113:1623-31
[5]Rossle M, Deibert P, Haag K, et al. Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propanolol for prevention of variceal rebleeding. Lancet 1997;349:1043-9
[6]Merli M, Salerno F, Riggio O, et al. Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotheraphy for the prevention of variceal bleeding in cirrhosis:a randomized multicenter trial. Hepatology 1998; 27:40-45
[7]Garcia-Villarreal L, Martinez-Lagares F. Sierra A, et al. Transjugular intrahepatic portosystemic shunt versus endoscopic sclerotheraphy for the prevention of variceal rebleeding afer recent variceal hemorrhage. Hepatology 1999; 29:27-32
[8]Lind CD, Malisch TW, Chong WK, et al. Incidence of shunt occlusion or stenosis following transjugular intrahepatic portosystemic shunt placement. Gastroenterology 1994; 106:1277-83
[9]Laberge JM, Somberg KA, Lake JR, et al. Two-year outcome following transjugular intrahepatic portosystemic shunt for variceal bleeding:results in 90 patients. Gastroenterology 1995;108(4):1143-51
[10]Haskal ZJ, Pentecost MJ, Soulen MC, et al. Transjugular intrahepatic portosystemic Shunt stenosis and revision:early and midterm results. Am J Roentgenol 1994; 163:439-44
[11]Saxon RR, Ross PL, Mendel-Hartvig J, et al. Transjugular intrahepatic portosystemic shunt patency and the importance of stenosis location in the development of recurrent symptoms. Radiology 1998;207:683-93
[12]Sterling KM, Darcy MD. Stenosis of Transjugular intrahepatic portosystemic shunts:Presentation and management. Am J Roentgenol 1997; 168:239-44
[13]Nazarian GK, Ferral H, Castaneda-Zuniga WR, et al. Development of stenosis in Transjugular intrahepatic portosystemic shunts. Radiology 1994; 192:231-4
[14]Latimer J, Bawa SM, Rees CJ, et al. Patency and reintervention rates during routine TPSS surveillance, Cardiovasc Interv Radiol 1998:21:234-9
[15]Saxon RR, Mendel-Hartvig J, Corless CL. et al. Bile duct injury as a major cause of stenosis and occlusion in transjugular intrahepatic portosystemic shunts: Comparative histopathologic analysis in humans and swine. J Vase Interv Radiol 1996; 7:487-97
[16]Jalan R, Harrison DJ, Redhead DN. et al. transjugular intrahepatic portosystemic shunt (TIPSS) occlusion and the role of biliary venous fistulae. J Hepatol 1996;24; 169-76.
[17]Ducoin H, EL-Khoury J, Rousseau H. et al. Histopathologic analysis of transjugular intrahepatic portosystemic shunt. Hepatology 1997;23:1064-9
[18]LaBerge JM, Ferrell LD, Ring EJ, et al. Histopathologic study of stenotic and occluded transjugular intrahepatic portosystemic shunts. J Vase Interv Radiol 1993;4:779-86
[19]Tanihata H, Saxon RR, Kubota Y, et al. transjugular intrahepatic portosystemic shunt with silicone-covered Wall-stents:Results in a swine model. Radiology 1997;205:181-4
[20]Otal P, Rousseau H, Vinel JP, et al. High occlusion rate in experimental transjugular intrahepatic portosystemic shunt created with a Dacron-covered nitionol stent. J Vasc Interv Radiol 1999; 10:183-6
[21]Nishimine K, Saxon RR, Kichikawa K, et al. Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts:experimental results in swne. Radiology 1995;196:341-7
[22]Haskal Z, Davis A, Mc Allister A, et al. PTFE-encapsulated endovascular stent-graft for transjugular intrahepatic portosystemic shunts:experimental evaluation. Radiology 1997;205:682-8
[23]Otal P, Smayra T, Bureau C, et al. Preliminary results of a new expanded-polytetrafluoroethylene-covered stent-graft for transjugular intrahepatic portosystemic shunt procedures. Am J Roentgenol 2002; 178:141-7
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