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Construction of Transjugular Intrahepatic Portosystemic Shunt： Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis
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Construction of Transjugular Intrahepatic Portosystemic Shunt： Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis
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Construction of Transjugular Intrahepatic Portosystemic Shunt： Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis
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Journal Article
Construction of Transjugular Intrahepatic Portosystemic Shunt： Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis
2016
Overview
Background： Balanced adjustment of the portal vein shunt volume during a transjugular intrahepatic portosystemic shunt （TIPS） is critical for maintaining liver perfusion and decreasing the incidence of liver insufficiency. A stent-graft is proved to be superior to a bare metal stent （BMS） for the construction of a TIPS. However, the clinical results of the combination application of stents and stent-grafts have not been determined. This study aimed to compare the technique of using a combination of stents and stent-grafts with using a single stent-graft to construct a TIPS. Methods： From April 2011 to November 2014, a total of fifty patients were randomly assigned to a stents-combination group （Group I, n = 28） or a stent-graft group （Group II, n - 22）. Primary patency rates were calculated. Clinical data, including the technical success rate, bleeding control results, incidence of encephalopathy, liver function preservation, and survival rate, were assessed. Results; Technically, the success rate was 100% for both groups. The primary patency rates at 1,2, and 3 years for Group I were 96%, 84%, and 77%, respectively; for Group II, they were 90%, 90%, and 78%, respectively. The survival rates at 1, 2, and 3 years for Group I were 79%, 74%, and 68%, respectively; for Group II, they were 82%, 82%, and 74%, respectively. The incidence of hepatic encephalopathy was 14.3% for Group I and 13.6% for Group II. The Child-Pugh score in Group I was stable at the end of the follow-up but had significantly increased in Group II （t - -2.474, P = 0.022）. Conclusions： The construction of a TIPS with either the single stent-graft or BMS/stent-graft combination is effective for controlling variceal bleeding. The BMS/stent-graft combination technique is superior to the stent-graft technique in terms of hepatic function preservation indicated by the Child-Pugh score. However, considering the clinical results of the TIPS, the two techniques are comparable in their primary shunt patency, incidence of encephalopathy and patient survival during the long-term follow-up.
Publisher
Wolters Kluwer - Medknow Publications,Medknow Publications and Media Pvt. Ltd,Lippincott Williams & Wilkins Ovid Technologies,Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing 100191, China,Medknow Publications & Media Pvt Ltd,Wolters Kluwer
Subject
/ Esophageal and Gastric Varices; Hypertension
/ Female
/ Hepatic Encephalopathy - diagnosis
/ Hepatic Encephalopathy - etiology
/ Humans
/ Hypertension, Portal - complications
/ Hypertension, Portal - mortality
/ Hypertension, Portal - surgery
/ Liver
/ Male
/ Original
/ Patients
/ Portasystemic Shunt, Transjugular Intrahepatic - adverse effects
/ Portasystemic Shunt, Transjugular Intrahepatic - methods
/ Stents
/ 临床分析
/ 分流
/ 支架技术
/ 肝功能
/ 金属
/ 门体
/ 门静脉
/ 随机分配
