摘要
目的 观察TIPS治疗肝细胞癌(HCC)伴门静脉癌栓(PVTT)及食管胃静脉曲张出血(EGVB)的价值。方法 回顾性分析30例因EGVB接受TIPS的HCC伴PVTT患者,观察TIPS技术成功率、止血率,TIPS前后门静脉压力梯度(PPG),术后再出血率、支架分流道通畅率、相关并发症发生率及患者总生存期(OS)。结果 30例TIPS技术成功率和止血率均为100%;TIPS前后平均PPG分别为(30.9±8.5)mmHg及(20.6±6.3)mmHg,差异有统计学意义(t=11.587,P<0.001)。TIPS并发症包括胆管损伤2例、肝动脉损伤1例、Ⅰ~Ⅱ级肝性脑病5例、Ⅲ级肝性脑病1例;未见肿瘤破裂或术后急性肝衰竭等并发症。随访过程中3例再出血,5例支架分流道闭塞。截至随访末共25例死亡,死因包括感染性休克1例、消化道出血1例、肿瘤进展或肝衰竭23例;中位OS为6.5个月。结论 TIPS治疗HCC伴PVTT及EGVB较为安全,可为后续局部治疗及联合药物系统治疗提供机会。
Objective To observe the value of TIPS for treating hepatocellular carcinoma(HCC) complicated with portal vein tumor thrombus(PVTT) and esophageal and gastric varices bleeding(EGVB). Methods Data of 30 patients with HCC and PVTT who underwent TIPS due to EGVB were retrospectively analyzed. The success rate of TIPS, hemostasis rate, portal vein pressure gradient(PPG) before and after TIPS, rebleeding rate, patency rate of TIPS stent shunt, as well as the incidence of TIPS related complications and overall survival(OS) of patients were observed. Results The success rate of TIPS and hemostasis rate were both 100%. The mean PPG before and after TIPS was(30.9±8.5)mmHg and(20.6±6.3)mmHg, respectively, being significantly different(t=11.587, P<0.001). After TIPS, bile duct injury was noticed in 2 cases, hepatic artery injury in 1 case, hepatic encephalopathy of grade Ⅰ—Ⅱ were found in 5 cases and of grade Ⅲ in 1 case. No tumor rupture nor postoperative acute liver failure occurred. During following-up, rebleeding occurred in 3 cases, stent shunt occlusion was detected in 5 cases. Up to the end of following-up, 25 patients died, including 1 case of infectious shock, 1 case of gastrointestinal bleeding, while 23 cases of tumor progression or liver failure, and the median OS was 6.5 months. Conclusion TIPS was safe for treating HCC complicated with PVTT and EGVB, hence providing an opportunity for followed local treatment and systemic drug treatment.
作者
梁礼聪
黄文薮
蔡明岳
郭永建
郭钊雄
林立腾
洪笑阳
朱康顺
LIANG Licong;HUANG Wensou;CAI Mingyue;GUO Yongjian;GUO Zhaoxiong;LIN Liteng;HONG Xiaoyang;ZHU Kangshun(Department of Interventional Minimally Invasive,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China)
出处
《中国介入影像与治疗学》
北大核心
2023年第1期7-11,共5页
Chinese Journal of Interventional Imaging and Therapy
基金
国家自然科学基金项目(82172043)
广东省医学科学技术研究基金项目(A2019187)
广州临床特色技术项目(0F04022)。
关键词
癌
肝细胞
高血压
门静脉
门体分流术
经颈静脉肝内
食管和胃静脉曲张
carcinoma
hepatocellular
hypertension
portal
portasystemic shunt
transjugular intrahepatic
esophageal and gastric varices
