| Objective:To observe the clinical effect of Viatorr stent and simulated Viatorr stent in transjugular intrahepatic portosystemic shunt(TIPS).Methods:The clinical data of 41 patients with esophagogastric variceal bleeding(EGVB)and refractory ascites treated with TIPS in Suining central hospital from July 2017 to February 2018 were retrospectively analyized.The patients were divided into Viatorr stent group(n=14)and simulated Viatorr stent group(Fluency covered stent combined with bare stent,n=27)according to the used stent during surgery.Surgical duration was recorded.Postoperative follow-up was performed for 1 year to observe relevant efficacy and complications.Measurement data were compared by the t test and counting data by the chi-square test or Fisher’s exact probability test.Ranked data were compared by the nonparametric rank sum test(mann-whitney test).The correlation between two categorical variables was analyzed using bivariate correlation analysis(pearson contingency coefficient).Results:1.The surgery was successful in both the Viatorr stent group and the simulated Viatorr stent group.Bleeding was stopped in 34 patients with EGVB,with a hemostasis rate of 100%.At 1 year after TIPS,the rebleeding rate was 0%and 13%,the remission rate of refractory ascites was 100%and 75%in the Viatorr stent group and the simulated Viatorr stent group respectively,showing no statistically significant differences(P>0.05).Among the patients with refractory ascites,2 patients experienced ascites decline by 2 grading standards and 1 patient experienced ascites decline by 3 grading standards in the Viatorr stent group,2 patients experienced ascites decline by 2 grading standards,1 patient experienced ascites decline by 1 grading standard and 1 patient didn’t experienced ascites decline in the simulated Viatorr stent group,there was no statistically significant differences(P>0.05).2.Portal vein pressure in the Viatorr stent group and the simulated Viatorr stent group decreased from(30.6±2.7)mmHg and(29.3±2.3)mmHg to(17.6±2.5)mmHg and(17.7±1.7)mmHg respectively.The difference value of portal vein pressure was(13.0±1.9)mmHg and(11.6 ±1.2)mmHg respectively.Surgical duration was(99.4 ± 9.7)min and(109.2±8.6)min respectively.Shunt failure rate was 0%and 29.6%respectively,with statistically significant differences(P<0.05).3.At 1 year after TIPS,Shunt failure rate was 0%and 29.6%in the Viatorr stent group and the simulated Viatorr stent group respectively,with statistically significant differences(P<0.05).The incidence of hepatic encephalopathy was 42.9%and 40.7%,the incidence of hepatic myelopathy was 0%and 3.7%,the incidence of hepatic failure was 7.1%and 3.7%,and the mortality was 7.1%and 7.4%in the Viatorr stent group and the simulated Viatorr stent group respectively,showing no statistically significant differences(P>0.05).4.There were some false positive and false negative results in diagnosis of TIPS dysfunction by ultrasonography.5.Bivariate correlation analysis of refractory ascites,hepatic myelopathy,hepatic failure and death demonstrated statistical significance(P<0.05).Conclusion:1.Application of Viatorr stent or simulated Viatorr stent in TIPS can reduce portal vein pressure to treat EGVB and refractory ascites effectively.2.Application of Viatorr stent in TIPS presents significantly reduced portal vein pressure,shorter surgical duration,lower shunt failure rate and don’t increase the incidence of hepatic encephalopathy,hepatic myelopathy,hepatic failure or mortality compare with simulated Viatorr stent at 1 year after TIPS.3.Ultrasonography would be influenced by many factors for the detection of TIPS dysfunction.4.Refractory ascites,hepatic myelopathy and hepatic failure are risk factors for mortality at 1 year after TIPS. |
