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

摘要

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 ofstents 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.