TACE联合TIPS治疗肝癌并发门静脉高压的疗效及对肝功能的影响

Efficacy of TACE combined with TIPS in the treatment of liver cancer complicated with portal hypertension and its effect on liver function

目的探究肝动脉化疗栓塞术(TACE)联合经颈静脉肝内门静脉内支架分流术(TIPS)在治疗肝癌并发门静脉高压中的疗效及对患者肝功能的影响。方法选择2016年4月至2018年3月于铜川市人民医院接受治疗的82例肝癌并发门静脉高压患者为研究对象,采用随机数字表法分为研究组与对照组,每组41例。对照组患者在常规治疗基础上进行TIPS治疗,研究组患者在常规治疗基础上采用TACE联合TIPS治疗。比较2组患者肿瘤治疗有效性,术前、术后15 d及术后30 d的谷氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)水平,统计2组患者术后并发症发生率及术后6、12、18个月生存率。结果研究组患者肿瘤治疗有效率明显高于对照组(P<0.05),门静脉压力显著低于对照组(P<0.05)。术后15 d,2组患者ALT及AST水平较术前有明显提高(P<0.05);术后30 d复查显示,2组患者ALT及AST均低于术后15 d(P<0.05),同时研究组显著低于对照组(P<0.05)。术后15 d和术后30 d,2组患者甲胎蛋白异质体3(AFP-L3)及甲胎蛋白(AFP)水平均较术前显著降低(P<0.05),术后30 d 2组患者AFP-L3及AFP水平均低于术后15 d(P<0.05);术后15 d和术后30 d,研究组AFP-L3及AFP水平均显著低于对照组(P<0.05)。术后研究组患者并发症发生率低于对照组(P<0.05)。术后18个月时研究组患者累积生存率显著高于对照组(P<0.05)。结论TACE联合TIPS治疗对肝癌并发门静脉高压具有较好的治疗效果,能够改善其肝功能和标志性指标水平,降低各类并发症发生率,提高其术后远期生存率。

Objective To explore the effect of transcatheter arterial chemoembolization(TACE)combined with transjugular intrahepatic portal stent shunt(TIPS)in the treatment of liver cancer complicated with portal hypertension and its influence on liver function.Methods From April 2016 to March 2018,82 patients with liver cancer complicated with portal hypertension who were treated in Tongchuan People′s Hospital were selected as the study objects.The patients were divided into study group and control group by random number table method,41 cases in each group.The patients in the control group were treated with TIPS on the basis of conventional treatment,while those in the study group were treated with TACE combined with TIPS on the basis of conventional treatment.The effect of tumor treatment,the levels of ALT and AST before operation,15 days and 30 days after operation were compared between the two groups,the incidence of postoperative complications and the survival rate of 6,12,18 months were analyzed.Results The efficiency of tumor treatment in the study group was significantly higher than that in the control group(P<0.05),and the pressure of portal vein was significantly lower than that in the control group(P<0.05).On the 15 days after operation,the levels of ALT and AST in the two groups were significantly higher than those before operation(P<0.05);on the 30 days after operation,the levels of ALT and AST in the two groups were significantly lower than those on the 15 days after operation(P<0.05),and the study group was significantly lower than the control group(P<0.05).On 15 days and 30 days after operation,the levels ofα-fetoprotein heterogeneity 3(AFP-L3)andα-fetoprotein(AFP)in the two groups were significantly lower than those before operation(P<0.05);the levels of AFP-L3 and AFP in both groups on 30 days after operation were lower than those on the 15 days(P<0.05);on 15 days and 30 days after operation,the levels of AFP-L3 and AFP in the study group were significantly lower than those in the control group(P<0.05).The incidence of postoperative complications in the study group was lower than that in the control group(P<0.05).At the 18 months after operation,the cumulative survival rate of the patients in the study group was significantly higher than that in the control group(P<0.05).Conclusion TACE combined with TIPS has a better therapeutic effect on liver cancer complicated with portal hypertension.It can improve the liver function and the level of markers,reduce the incidence of various complications,and improve the long-term survival rate.