综述
经颈静脉肝内门体分流术治疗门静脉高压的支架应用现状及进展
穰政兴
廖马玲
李波
翁家聪
李芳
刘博阳
戴先鹏
作者及单位信息
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DOI: 10.3760/cma.j.cn101411-20201217-00127
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摘要

肝硬化门静脉高压症失代偿时常伴发食管-胃底静脉曲张出血、顽固性腹水等并发症,且食管-胃底静脉曲张出血是肝硬化门静脉高压最危急的并发症之一,一旦出现将危及生命。随着介入治疗技术的发展,经颈静脉肝内门体分流术(TIPS)治疗门静脉高压相关并发症(如食管胃静脉曲张破裂出血、顽固性腹水等),尤其是TIPS 专用可扩展聚四氟乙烯覆膜支架(Viatorr覆膜支架)的临床应用,使得其成为肝硬化门脉高压相关并发症的主要治疗方法。术后门静脉通畅率显著升高。尽管如此,肝性脑病、肝衰竭等术后并发症的出现,仍是阻碍TIPS发展的主要原因,甚至多数学者认为TIPS是肝硬化或门脉高压尤其是伴有门静脉系血栓形成患者的禁忌。因此在TIPS手术中选择合适的支架及合适的支架植入方式至关重要。将对TIPS支架的种类、植入方式、优缺点以及相关进展进行综述。

肝硬化;门静脉高压;经颈静脉肝内门体分流术;Viatorr覆膜支架;组合支架
引用本文

穰政兴,廖马玲,李波,等. 经颈静脉肝内门体分流术治疗门静脉高压的支架应用现状及进展[J]. 中华血管外科杂志,2022,07(03):221-224.

DOI:10.3760/cma.j.cn101411-20201217-00127

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门脉高压食管胃底静脉曲张出血是造成肝硬化患者死亡率升高的主要并发症 1,首发急性上消化道静脉曲张出血的患者死亡率为15%~30% 2 , 3 , 4 , 5 , 6 , 7。经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt,TIPS)是一项治疗肝硬化门静脉高压的介入治疗技术。通过影像学引导,在门静脉和肝静脉或下腔静脉之间介入性建立分流,放置可扩张的血管内支架,使门静脉血流分流至体循环,从而降低门体压力梯度 8,同时还可对食管胃底曲张静脉实施介入栓塞治疗 9。随着此技术的发展,尤其专用覆膜支架(Viatorr,美国Gore公司)的应用,使其在临床上广泛应用于食管胃底静脉曲张出血、顽固性胸腹腔积液、布加综合征等的治疗 10 , 11,但由于肝性脑病、肝功能衰竭、再出血等术后并发症的出现,其中远期疗效并不乐观,个体死亡率并无可观的改善。因此,近年来有术者采用组合支架建立分流系统,即裸金属支架连接门静脉与下腔静脉,精确定位,并扩张二者间的肝实质,建立肝实质段的分流通道,再以相应长度覆膜支架覆盖此肝实质段,小样本数据证实其创伤小,定位精准,上消化道出血止血效果显著及门静脉分支通畅率高,具有极高的发展及临床应用潜力。
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参考文献
[1]
Kim DJ , Darcy MD , Mani NB ,et al. Modified balloon-occluded retrograde transvenous obliteration (BRTO) techniques for the treatment of gastric varices: vascular plug-assisted retrograde transvenous obliteration (PARTO)/coil-assisted retrograde transvenous obliteration (CARTO)/balloon-occluded antegrade transvenous obliteration (BATO)[J]. Cardiovasc Intervent Radiol, 2018,41(6):835-847. DOI: 10.1007/s00270-018-1896-1 .
返回引文位置Google Scholar
百度学术
万方数据
[2]
Huang Z , Yao Q , Zhu J ,et al. Efficacy and safety of transjugular intrahepatic portosystemic shunt (TIPS) created using covered stents of different diameters: a systematic review and meta-analysis[J]. Diagn Interv Imaging, 2021,102(5):279-285. DOI: 10.1016/j.diii.2020.11.004 .
返回引文位置Google Scholar
百度学术
万方数据
[3]
Weber CN , Nadolski GJ , White SB ,et al. Long-term patency and clinical analysis of expanded polytetrafluoroethylene-covered transjugular intrahepatic portosystemic shunt stent grafts[J]. J Vasc Interv Radiol, 2015,26(9):1257-1265; quiz 1265. DOI: 10.1016/j.jvir.2015.04.005 .
返回引文位置Google Scholar
百度学术
万方数据
[4]
郭芳芳,吴正阳,周朋利,. 经颈静脉肝内门体分流术治疗门静脉海绵样变合并食管胃底静脉出血价值分析[J]. 中华医学杂志, 2020,100(5):387-390. DOI: 10.3760/cma.j.issn.0376-2491.2020.05.014 .
返回引文位置Google Scholar
百度学术
万方数据
[5]
李震,蔡高坡. 门静脉系血栓形成的诊治进展[J/CD]. 中国血管外科杂志(电子版), 2019,11(1):4-6. DOI: 10.3969/j.issn.1674-7429.2019.01.002 .
返回引文位置Google Scholar
百度学术
万方数据
[6]
Mallet M , Rudler M , Thabut D . Variceal bleeding in cirrhotic patients[J]. Gastroenterol Rep (Oxf), 2017,5(3):185-192. DOI: 10.1093/gastro/gox024 .
返回引文位置Google Scholar
百度学术
万方数据
[7]
Sun XY , Wang GC , Wang J ,et al. Transjugular intrahepatic portosystemic shunt is effective in patients with chronic portal vein thrombosis and variceal bleeding[J]. Hepatobiliary Pancreat Dis Int, 2021,20(2):128-136. DOI: 10.1016/j.hbpd.2020.12.016 .
返回引文位置Google Scholar
百度学术
万方数据
[8]
Sarwar A , Weinstein JL , Novack V ,et al. Causes and rates of 30-day readmissions after transjugular intrahepatic portosystemic shunts[J]. AJR Am J Roentgenol, 2020,215(1):235-241. DOI: 10.2214/AJR.19.21732 .
返回引文位置Google Scholar
百度学术
万方数据
[9]
Qi X , Liu L , Bai M ,et al. Transjugular intrahepatic portosystemic shunt in combination with or without variceal embolization for the prevention of variceal rebleeding: a meta-analysis[J]. J Gastroenterol Hepatol, 2014,29(4):688-696. DOI: 10.1111/jgh.12391 .
返回引文位置Google Scholar
百度学术
万方数据
[10]
Lo GH , Liang HL , Chen WC ,et al. A prospective, randomized controlled trial of transjugular intrahepatic portosystemic shunt versus cyanoacrylate injection in the prevention of gastric variceal rebleeding[J]. Endoscopy, 2007,39(8):679-685. DOI: 10.1055/s-2007-966591 .
返回引文位置Google Scholar
百度学术
万方数据
[11]
Wang HL , Lu WJ , Zhang YL ,et al. Comparison of transjugular intrahepatic portosystemic shunt in the treatment of cirrhosis with or without portal vein thrombosis: a retrospective study[J]. Front Med (Lausanne), 2021,8:737984. DOI: 10.3389/fmed.2021.737984 .
返回引文位置Google Scholar
百度学术
万方数据
[12]
Rössle M . TIPS: 25 years later[J]. J Hepatol, 2013,59(5):1081-1093. DOI: 10.1016/j.jhep.2013.06.014 .
返回引文位置Google Scholar
百度学术
万方数据
[13]
Haskal ZJ , Rees CR , Ring EJ ,et al. Reporting standards for transjugular intrahepatic portosystemic shunts. Technology assessment committee of the SCVIR[J]. J Vasc Interv Radiol, 1997,8(2):289-297. DOI: 10.1016/s1051-0443(97)70558-x .
返回引文位置Google Scholar
百度学术
万方数据
[14]
陈辉,吕勇,王秋和,. 经颈静脉肝内门体分流术专家共识[J]. 临床肝胆病杂志, 2017,33(7) :1218-1228. DOI: CNKI:SUN:LCGD.0.2017-07-004
返回引文位置Google Scholar
百度学术
万方数据
[15]
Saad WE , Darwish WM , Davies MG ,et al. Stent-grafts for transjugular intrahepatic portosystemic shunt creation: specialized TIPS stent-graft versus generic stent-graft/bare stent combination[J]. J Vasc Interv Radiol, 2010,21(10):1512-1520. DOI: 10.1016/j.jvir.2010.06.009 .
返回引文位置Google Scholar
百度学术
万方数据
[16]
Hoppe H , Wang SL , Petersen BD . Intravascular US-guided direct intrahepatic portocaval shunt with an expanded polytetrafluoroethylene-covered stent-graft[J]. Radiology, 2008,246(1):306-314. DOI: 10.1148/radiol.2461062191 .
返回引文位置Google Scholar
百度学术
万方数据
[17]
Patel RK , Chandel K , Tripathy TP ,et al. Complications of transjugular intrahepatic portosystemic shunt (TIPS) in the era of the stent graft - What the interventionists need to know?[J]. Eur J Radiol, 2021,144:109986. DOI: 10.1016/j.ejrad.2021.109986 .
返回引文位置Google Scholar
百度学术
万方数据
[18]
Tong H , Gan C , Wei B ,et al. Risk factors for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation in patients with liver cirrhosis[J]. J Dig Dis, 2021,22(1):31-40. DOI: 10.1111/1751-2980.12957 .
返回引文位置Google Scholar
百度学术
万方数据
[19]
Lakhoo J , Gaba RC . Outcomes of transjugular intrahepatic portosystemic shunt creation for flow-enabled dissolution of spleno-mesenterico-portal venous thrombosis[J]. Diagn Interv Imaging, 2016,97(11):1085-1093. DOI: 10.1016/j.diii.2016.07.005 .
返回引文位置Google Scholar
百度学术
万方数据
[20]
Gaba RC , Omene BO , Podczerwinski ES ,et al. TIPS for treatment of variceal hemorrhage: clinical outcomes in 128 patients at a single institution over a 12-year period[J]. J Vasc Interv Radiol, 2012,23(2):227-235. DOI: 10.1016/j.jvir.2011.10.015 .
返回引文位置Google Scholar
百度学术
万方数据
[21]
Arroyo V , Ginès A , Saló J . A European survey on the treatment of ascites in cirrhosis[J]. J Hepatol, 1994,21(4):667-672. DOI: 10.1016/s0168-8278(94)80116-9 .
返回引文位置Google Scholar
百度学术
万方数据
[22]
Arroyo V , Rodés J . A rational approach to the treatment of ascites[J]. Postgrad Med J, 1975,51(598):558-562. DOI: 10.1136/pgmj.51.598.558 .
返回引文位置Google Scholar
百度学术
万方数据
[23]
Bercu ZL , Fischman AM , Kim E ,et al. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts[J]. AJR Am J Roentgenol, 2015,204(3):654-661. DOI: 10.2214/AJR.14.12885 .
返回引文位置Google Scholar
百度学术
万方数据
[24]
Qi X , Tian Y , Zhang W ,et al. Covered versus bare stents for transjugular intrahepatic portosystemic shunt: an updated meta-analysis of randomized controlled trials[J]. Therap Adv Gastroenterol, 2017,10(1):32-41. DOI: 10.1177/1756283X16671286 .
返回引文位置Google Scholar
百度学术
万方数据
[25]
Hausegger KA , Karnel F , Georgieva B ,et al. Transjugular intrahepatic portosystemic shunt creation with the Viatorr expanded polytetrafluoroethylene-covered stent-graft[J]. J Vasc Interv Radiol, 2004,15(3):239-248. DOI: 10.1097/01.rvi.0000116194.44877.c1 .
返回引文位置Google Scholar
百度学术
万方数据
[26]
Yang Z , Han G , Wu Q ,et al. Patency and clinical outcomes of transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stents versus bare stents: a meta-analysis[J]. J Gastroenterol Hepatol, 2010,25(11):1718-1725. DOI: 10.1111/j.1440-1746.2010.06400.x .
返回引文位置Google Scholar
百度学术
万方数据
[27]
Wang L , Xiao Z , Yue Z ,et al. Efficacy of covered and bare stent in TIPS for cirrhotic portal hypertension: a single-center randomized trial[J]. Sci Rep, 2016,6:21011. DOI: 10.1038/srep21011 .
返回引文位置Google Scholar
百度学术
万方数据
[28]
Qi X , Guo W , He C ,et al. Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: techniques, indications and results on 51 Chinese patients from a single centre[J]. Liver Int, 2014,34(8):1164-1175. DOI: 10.1111/liv.12355 .
返回引文位置Google Scholar
百度学术
万方数据
[29]
Liu J , Meng J , Zhou C ,et al. A new choice of stent for transjugular intrahepatic portosystemic shunt creation: Viabahn ePTFE covered stent/bare metal stent combination[J]. J Interv Med, 2021,4(1):32-38. DOI: 10.1016/j.jimed.2020.10.003 .
返回引文位置Google Scholar
百度学术
万方数据
[30]
Geeratikun Y , Timmermans H , Uchida B ,et al. VIDEO: Technique to restrict the Gore Viatorr stent-graft for TIPS reduction[J]. AJR Am J Roentgenol, 2018,210(4):W172. DOI: 10.2214/AJR.17.19027 .
返回引文位置Google Scholar
百度学术
万方数据
[31]
Ferral H , Gomez-Reyes E , Fimmel CJ . Post-transjugular intrahepatic portosystemic shunt follow-up and management in the VIATORR era[J]. Tech Vasc Interv Radiol, 2016,19(1):82-88. DOI: 10.1053/j.tvir.2016.01.009 .
返回引文位置Google Scholar
百度学术
万方数据
[32]
蔡炜,诸葛宇征,张建武,. 不同支架经颈静脉肝内门体静脉分流术治疗肝硬化食管胃静脉曲张出血的安全性和疗效研究[J]. 中华肝脏病杂志, 2015,23(4):258-264. DOI: 10.3760/cma.j.issn.1007-3418.2015.04.006 .
返回引文位置Google Scholar
百度学术
万方数据
[33]
赵世录,王昌明,傅军,. 组合支架在经颈静脉肝内门体分流术中应用的随访结果[J]. 中国微创外科杂志, 2018,18(4):294-297.
返回引文位置Google Scholar
百度学术
万方数据
[34]
Raissi D , Yu Q , Nisiewicz M ,et al. Parallel transjugular intrahepatic portosystemic shunt with Viatorr ® stents for primary TIPS insufficiency: case series and review of literature [J]. World J Hepatol, 2019,11(2):217-225. DOI: 10.4254/wjh.v11.i2.217 .
返回引文位置Google Scholar
百度学术
万方数据
[35]
Xu B , Liu J , Liu S ,et al. Clinical effect of single covered stent and double covered stent on TIPS in the treatment of hemorrhage due to rupture of esophageal and gastric varices in cirrhosis and its influence on immune function[J]. Exp Ther Med, 2019,18(6):4259-4264. DOI: 10.3892/etm.2019.8106 .
返回引文位置Google Scholar
百度学术
万方数据
备注信息
A
戴先鹏,Email: mocdef.aabnisgnepnaixiadpp
B

穰政兴, 廖马玲, 李波, 等. 经颈静脉肝内门体分流术治疗门静脉高压的支架应用现状及进展[J]. 中华血管外科杂志, 2022, 7(3): 221-224. DOI: 10.3760/cma.j.cn101411-20201217-00127.

C
所有作者均声明不存在利益冲突
D
湖南省研究生科研创新项目 (CX20200976)
湖南省卫健委科研项目 (20201955)
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