经颈静脉肝内门静脉分流术介入治疗原发性肝癌合并门静脉高压症的临床研究

Interventional treatment in primary hepatocellular carcinoma patients with portal hypertension

目的探讨原发性肝癌合并门静脉高压患者采用经颈静脉肝内门静脉分流术(TIPS)治疗的价值。方法 32例原发性肝癌合并门静脉高压症患者采用TIPS治疗(治疗组),21例采用药物保守治疗(对照组),分析手术治疗疗效,随访TIPS组患者出院后的手术并发症出现情况,并随访所有患者的存活时间及死亡原因。结果 32例患者手术成功,术后门静脉压力下降(13.1±1.3)mmHg,术后2周复查,食管胃底静脉曲张明显缓解,术后TBIL、ALT测定值与术前比较,差异有统计学意义(P<0.05);术后Child评分与术前比较,差异有统计学意义(P<0.05),术后随访TIPS组出现肝性脑病6例,支架梗阻4例,患者存活时间为(5.1±1.1)个月,死亡原因为多脏器功能衰竭22例(68.8%),上消化道出血4例(12.5%),其他原因6例(18.8%);对照组患者存活时间为(1.1±0.6)个月,死亡原因为多脏器功能衰竭12例(57.1%)、上消化道出血7例(33.3%),其他原因2例(9.5%)。结论 TIPS手术对原发性肝癌患者合并门静脉高压症的治疗,安全有效,有临床推广应用的价值。

Objective To evaluate the treatment value of transjugular intrahepatic portosystemic shunt （TIPS） in the treatment of primary hepatoeellular carcinoma patients with portal hypertension. Methods Thirty two cases with pri- mary hepatocellular carcinoma and portal hypertension were conservatively, the postoperative curative effect was analyzed, time and the reason of death of the patients that discharged treated with TIPS, 21 cases were treated with medicine were folowed up the surgical complications, the survival from hospital. Results Thirty two cases were succeeded, （13.1±1.3） mm Hg was dropped in postoperative portal vein pressure, reviewed after two weeks, esophagogastric varices was eased obviously, compared the measured value of TBIL, ALT in postoperation with that in preoperation, the dif- ference was statistically significant （P 〈 0.05）; Cmopared the child score of postoperation with that in preoperation, the difference was statistically significant （P 〈 0.05）, TIPS group was followed up, 6 cases were hepatic encephalopathy, 4 cases were stem obstruction, the survival time of the patients was （5.1±1.1） months, the causes of death were multiple organ failure in 22 cases （68.8%）, upper gastrointestinal bleeding in 4 cases （12.5%）, other causes in 6 cases （18.8% %）. The survival time of control group was （1.1±0.6） months, the causes of death were multiple organ failure in 12 cas- es （57.1%）, upper gastrointestinal bleeding in 7 cases （33.3%）, other causes in 6 cases （18.8%）. Conclusion TIPS is effective and safe to treat primary hepatocellular carcinoma patients with portal hypertension, it has the clinical value to populize and apply.