摘要
目的评价经颈静脉肝内门体分流术(TIPS)联合介入治疗原发性肝癌伴门静脉高压症的安全性和疗效。方法收集2013年10月至2017年12月安徽省肿瘤医院收治的141例肝癌伴肝硬化门静脉高压症患者的病历资料,根据纳入、排除标准TIPS联合介入治疗组纳入32例,单纯介入治疗组按年龄、性别、肿瘤最大径、Child-Pugh分级等与TIPS联合介入治疗组匹配后纳入29例。观察TIPS的疗效,比较两组患者治疗后6、12、24个月相关并发症发生情况和预后。统计学方法采用独立样本t检验、Mann-WhitneyU检验和卡方检验,采用Kaplan-Merier法进行生存分析。结果TIPS联合介入治疗组和单纯介入治疗组年龄、性别、肿瘤最大径、Child-Pugh分级、Child-Turcotte-Pugh(CTP)评分、巴塞罗那分期、介入治疗方式、肝硬化原因、门静脉高压症相关症状、伴门静脉癌栓、ALT、TBil差异均无统计学意义(P均>0.05)。TIPS联合介入治疗组TIPS手术成功率为100%(32/32),TIPS术后门静脉高压症相关症状均缓解,缓解率为100%(32/32)。与TIPS术前相比,TIPS术后患者门静脉压力降低[(36.5±6.9)cmH2O比(25.5±5.6)cmH2O(1 cmH2O=0.098 kPa)],门静脉直径缩小[(15.9±3.5)mm比(13.7±2.7)mm],腹水量减少[腹围(105.6±13.9)cm比(88.0±9.8)cm],红细胞计数和血红蛋白水平均升高[分别为(2.6±0.8)×10^12/L比(3.3±1.3)×1012/L、(78.9±15.5)g/L比(108.4±14.6)g/L],差异均有统计学意义(t=2.866、3.105、10.769、-3.548、-3.869,P均<0.01)。TIPS术后6个月支架通畅率为100%(32/32),术后12个月通畅率为94%(30/32),术后24个月通畅率为84%(27/32)。治疗后6、12、24个月TIPS联合介入治疗组患者的腹水发生率分别为0、3.1%(1/32)、9.4%(3/32),出血发生率分别为3.1%(1/32)、9.4%(3/32)、15.6%(5/32),均低于单纯介入治疗组[分别为13.8%(4/29)、27.6%(8/29)、65.5%(19/29)和20.7%(6/29)、34.5%(10/29)、62.1%(18/29)],差异均有统计学意义(χ^2=4.72、7.24、20.80和4.62、
Objective To evaluate the safety and efficacy of combination of transjugular intrahepatic portosystemic shunt(TIPS)combined with interventional therapy for primary hepatic carcinoma complicated with portal hypertension.Methods From October 2013 to December 2017,medical records of 141 patients with primary hepatic carcinoma complicated with portal hypertension hospitalized and treated in Anhui Provincial Cancer Hospital were collected.According to the inclusion and exclusion criteria,32 cases were in the TIPS combined with interventional treatment group and 29 cases were included in the intervention-only group after age,gender,mean tumor diameter and Child-Pugh classification matched with TIPS combined with intervention treatment group.The efficacy of TIPS was obsented,and the related complications and prognosis of the two groups at six,12 and 24 months after treatment were compared.Independent sample t test,Mann-Whitney U test and Chi-square test were used for statistical analysis,and Kaplan-Merier method was used for survival analysis.Results There were no statistically significant differences between TIPS combined with intervention group and intervention-only group in age,gender,mean tumor diameter,Child-Pugh classification,Child-Turcotte-Pugh(CTP)score,Barcelona staging,interventional treatment,causes of liver cirrhosis,portal hypertension related symptoms,portal vein tumor thrombus,alanine aminotransferase(ALT),and total bilirubin(TBil)(all P>0.05).The success rate of TIPS of patients in TIPS combined with intervention group was 100%(32/32).All the portal hypertension related symptoms after TIPS were relieved,and the remission rate was 100%(32/32).Compared with that before TIPS,after TIPS,the portal vein pressure decreased((36.5±6.9)cmH2O vs.(25.5±5.6)cmH2O(1 cmH2O=0.098 kPa)),the diameter of portal vein decreased((15.9±3.5)mm vs.(13.7±2.7)mm),and ascites volume decreased(abdominal circumference((105.6±13.9)cm vs.(88.0±9.8)cm),red blood cell count((2.6±0.8)×10^12/L vs.(3.3±1.3)×1012/L)and hemoglobin
作者
侯昌龙
许军
秦汉林
周磊
朱先海
施长杲
费一鹏
Hou Changlong;Xu Jun;Qin Hanlin;Zhou Lei;Zhu Xianhai;Shi Changgao;Fei Yipeng(Department of Intervention,The First Affiliated Hospital of USTC West District,Anhui Provincial Cancer Hospital,Hefei 230031,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2020年第7期474-479,共6页
Chinese Journal of Digestion
关键词
肝肿瘤
高血压
门静脉
门体分流术
经颈静脉肝内
存活率
介入治疗
Liver neoplasms
Hypertension,portal
Portasystemic shunt,transjugular intrahepatic
Survival rate
Interventional therapy
