摘要
目的 探讨经颈静脉肝内门体分流术(TIPS)治疗肝癌合并门静脉高压(PHT)患者的临床价值。方法 选取2017年5月至2021年5月在中国科学技术大学附属第一医院接受TIPS治疗的肝癌合并PHT患者31例作为研究组,筛选接受保守治疗患者36例作为对照组。根据改良实体瘤疗效评价标准(m RECIST)评估患者疗效,比较两组并发症发生情况和无并发症生存时间。结果 TIPS手术成功率为100%。术后门静脉压力平均降低19.57 cmH_(2)O(95%CI=17.88~21.26),门静脉直径平均缩小4.25 mm(95%CI=2.85~5.66),差异有统计学意义(t=23.672、6.178,均P<0.05)。术后1年支架畅通率为90%(28/31),2年畅通率为87%(27/31)。研究组、对照组治疗后1年内肝性脑病(HE)发生率差异无统计学意义[32%(10/31)、25%(9/36),χ^(2)=0.432,P=0.510]。研究组HE患者12、20个月累积生存率和中位生存时间均高于对照组(78.8%、39.4%和19个月比33.3%、0和8个月,均P<0.05)。研究组、对照组中位无并发症生存时间分别为153 d、58 d,30 d和90 d无并发症生存率分别为90.3%和61.3%,77.8%和30.6%,研究组优于对照组(均P<0.01)。研究组腹水、再出血发生率均低于对照组(χ^(2)=16.810、15.085,均P<0.01)。研究组、对照组分别有19例、20例患者接受肝癌介入治疗,手术均获得成功。两组不良反应发生率和治疗3个月后肿瘤反应率差异无统计学意义(均P>0.05)结论 TIPS治疗肝癌合并PHT具有一定的临床应用价值。
Objective To assess the clinical value of transjugular intrahepatic portosystemic shunt(TIPS) in the treatment of patients with hepatocellular carcinoma(HCC) complicated by portal hypertension(PHT).Methods Thirty-one patients with HCC complicated by PHT, who were admitted to the Affiliated First Hospital of University of Science and Technology of China to receive TIPS between May 2017 and May 2021,were selected and used as the study group, and other 36 patients who received conservative treatment were selected and used as the control group. Modified response evaluation criteria in solid tumor(mRECIST) was adopted to evaluate the clinical efficacy, and the incidence of complications and the complication-free survival time were compared between the two groups. Results The technical success rate of TIPS was 100%. The average postoperative portal vein pressure decreased by 19.57 cm H_(2)O(95%CI=17.88-21.26), and the portal vein diameter decreased by 4.25 mm(95%CI=2.85-5.66), the differences were statistically significant(t=23.672 and t=6.178,both P<0.05). The postoperative one-year stent patency rate was 90%(28/31), and the postoperative 2-year stent patency rate was 87%(27/31). The difference in the incidence of hepatic encephalopathy(HE) within one year after treatment between the study group and the control group was not statistically significant(32% versus 25%,χ^(2)=0.432, P =0.510). The postoperative12-month and 20-month cumulative survival rates and the median survival time in the study group were higher than those in the control group(78.8% versus 33.3% versus 39.4%.and 19 months versus 8 months;all P<0.05). The median complication-free survival time in the study group and the control group was 153 d and 58 d respectively;the complication-free survival rates at 30 d and 90 d in the study group were 90.3% and 77.8% respectively, which were better than 61.3% and 30.6% respectively in the control group(all P<0.01). The incidences of ascites and rebleeding in the study group were remarkably lower than those in th
作者
侯昌龙
熊柏柱
许军
周磊
费一鹏
施长杲
朱先海
谢韬
HOU Changlong;XIONG Baizhu;XU Jun;ZHOU Lei;FEI Yipeng;SHI Changgao;ZHU Xianhai;XIE Tao(Department of Intervention of West District,Affiliated First Hospital of University of Science and Technology of China,Hefei,A nhui Povince 230031,China)
出处
《介入放射学杂志》
CSCD
北大核心
2023年第4期320-325,共6页
Journal of Interventional Radiology
关键词
肝癌
门静脉高压
经导管动脉化疗栓塞术
经颈静脉肝内门体分流术
hepatocellular carcinoma
portal hypertension
transarterial chemoembolization
transjugular intrahepatic portosystemic shunt
