[Effect of underdilated stent on the occurrence of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt creation].

Objective: To evaluate whether underdilated stent could reduce the occurrence of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) creation. Methods: A total of 197 patients with decompensated liver cirrhosis, who had underwent TIPS creation at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, were analyzed retrospectively, including 110 males and 87 females with age 25-79 (54±11) years old. Uncovered and covered stents with 8 mm diameter were implanted in all subjects, and then dilated by balloon catheters with 6 mm or 8 mm diameter. The patients were divided into two groups, including underdilated group (6 mm, n=105) and control group (8 mm, n=92).Kaplan-Meier curves were used to illustrate cumulative rate of HE, and the differences were assessed with the log-rank test. Multivariate analyses with a Cox regression model were conducted to explore the risk factors for HE. Results: During a median follow-up period of 29 (12-54) months, 16 (15.2%) patients developed HE in the underdilated group and 27 (29.3%) patients in the control group. There was a significant difference in the cumulative rate of HE (P=0.014), but no statistical differences were found in terms of variceal rebleeding, shunt dysfunction and survival between the two groups (P=0.608, P=0.659, P=0.968). In multivariated analysis, group assignment (underdilated vs. control, HR=0.291, 95%CI 0.125-0.674, P=0.004) was identified as an independent risk factor for HE after TIPS creation. Conclusion: Underdilated TIPS could reduced the risk of HE compared with completely dilated TIPS, with comparable risk of variceal rebleeding, shunt dysfunction and mortality. And it is worthy of applying this technique to a large sample of patients in clinical practice.目的： 探讨支架亚扩张能否降低经颈静脉肝内门体分流术（transjugular intrahepatic portosystemic shunt，TIPS）后肝性脑病发生率。 方法： 回顾性分析2017年3月至2020年9月于华中科技大学同济医学院附属协和医院介入科行TIPS治疗的197例肝硬化失代偿期患者，其中男性110例、女性87例，年龄25~79（54±11）岁。所有患者术中均置入直径8 mm裸支架+覆膜支架，并采用直径6 mm或8 mm球囊扩张。根据球囊直径大小，患者分为亚扩张组（6 mm，105例）与对照组（8 mm，92例）。术后累积肝性脑病发生率采用Kaplan-Meier法进行分析，两组间的比较采用log-rank检验。采用多因素Cox回归分析探讨TIPS术后发生肝性脑病的独立危险因素。 结果： 两组患者术后中位随访时间为29（12~54）个月，亚扩张组患者16例（15.2%）出现肝性脑病，显著低于对照组27例（29.3%）（P=0.014），但两组患者消化道再出血率、支架功能障碍率及生存率差异无统计学意义（P=0.608，P=0.659，P=0.968）。在多变量Cox回归分析中，分组（亚扩张组 比 对照组）（HR=0.291，95%CI 0.125~0.674，P=0.004）是TIPS术后肝性脑病发生的独立危险因素。 结论： 支架亚扩张可降低TIPS术后肝性脑病发生率，且不增加消化道再出血率、支架功能障碍率及死亡风险，可在临床上进一步推广应用。.