肝癌患者门静脉高压症静脉曲张破裂出血的TIPS治疗

TIPS Treatment on Variceal Bleeding Due to Portal Hypertension of Patients with Hepatocellular Carcinoma

目的探讨经颈内静脉肝内门腔静脉分流术(TIPS)治疗肝癌患者门静脉高压症静脉曲张破裂出血的有效性和安全性及TIPS术前的病例选择。方法回顾性分析48例肝癌合并门静脉高压症静脉曲张破裂出血病例,评估手术技术成功率、术后情况、术后肝性脑病、再出血、死亡原因等;将病例的生存期资料行Kaplan-Meier生存分析,分析肝功能Child-Pugh分级与术后生存时间的关系。结果 48例患者全部成功行TIPS治疗,门静脉压力平均较术前降低约10.6 mmHg(1mmHg=0.133 kPa),静脉曲张出血有效控制,腹水、腹胀、腹泻等症状明显缓解。术后中位生存时间约5.0月,Child-Pugh分级A到C组术后中位生存时间依次缩短。结论 TIPS是治疗肝癌患者门静脉高压静脉曲张破裂出血的有效且安全的方法,肝功能状态是术前手术病例筛选的重要指标。

Objective To evaluate the therapeutic efficacy and safety of transjugular intrahepatic portosystemic shunt（TIPS） for the treatment on variceal bleeding due to portal hypertension（PHT）of patients with hepatocellular carcinoma（HCC）,and to evaluate factors for case selection for TIPS.Methods 48 patients with HCC complicated variceal bleeding due to portal hypertension performed TIPS were retrospected.Of the 48 patients,the average age was 50.8 years.Related information after TIPS,such as treatment success,complications,causes of death and so on,were assessed.The data of survival time of the 48 patients after treatment was collected by follow-up.The Kaplan-Meier method was used to conduct the survival analyses.Results TIPS was successful in 48 cases,the mean portal vein pressure was reduced about 10.6 mmHg（1mmHg=0.133kPa）.After TIPS,variceal bleeding was controlled,the ascites and the clinical symptoms were relieved.According to the follow-up,incidence rate of hepatic encephalopathy complicated with TIPS was 18.8% and rebleeding was 27.0%.The median survival time of the patients was about 5.0 months,and it shortened from Child-Pugh class A to C.Conclusion TIPS is one of effective and safe therapeutic methods to control variceal bleeding due to portal hypertension of patients with HCC.However,liver function is an important factor for case selection for TIPS.