经导管动脉化疗栓塞治疗经颈静脉肝内门体分流术后肝细胞癌临床应用评价

Clinical application of transcatheter arterial chemoembolization in treating patients with hepatocellular carcinoma after receiving transjugular intrahepatic portosystemic shunt

目的探讨经导管动脉化疗栓塞术(TACE)治疗经颈静脉肝内门体分流术(TIPS)后肝细胞癌(HCC)的安全性和近期效果。方法回顾性分析2014年8月至2019年12月在徐州医科大学附属医院接受TACE治疗的41例HCC患者临床资料。其中20例TACE术前存在TIPS治疗患者为观察组,同期21例TACE术前无TIPS治疗患者为对照组。比较两组间TACE治疗前后肝功能、血常规,术后不良反应、并发症发生及严重不良事件发生情况,根据改良实体瘤疗效评价标准(m RECIST)结合影像学检查评价术后近期疗效。结果两组患者基线特征差异无统计学意义(P>0.05)。两组TACE术均获成功,无严重并发症和手术相关死亡。除血清白蛋白(ALB)外,两组间术前、术后1周总胆红素(TBil)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、白细胞(WBC)、红细胞(RBC)、血小板(PLT)差异均无统计学意义(P>0.05)。观察组与对照组相比,患者术后1周腹痛、发热、恶心、呕吐等不良反应发生率和术后6个月肿瘤反应率差异均无统计学意义(P>0.05)。结论即使HCC患者之前接受过TIPS治疗,行TACE术仍安全有效。

Objective To investigate the safety and short-term efficacy of transcatheter arterial chemoembolization(TACE) in treating patients with hepatocellular carcinoma(HCC) who had previously received transjugular intrahepatic portosystemic shunt(TIPS). Methods The clinical data of 41 HCC patients, who received TACE at the Affiliated Hospital of Xuzhou Medical University of China between August 2014 and December 2019, were retrospectively analyzed. Twenty patients who had previously received TIPS were used as the study group, while other 21 patients who had not received TIPS before were used as the control group.The pre-TACE and post-TACE liver functions, blood routine testing, postoperative adverse reactions,complications and serious adverse events were compared between the two groups. Based on the modified Response Evaluation Criteria in Solid Tumor(mRECIST) criteria and imaging manifestations the short-term therapeutic efficacy was evaluated. Results No statistically significant differences in baseline characteristics existed between the two groups(P>0.05 in all). Successful TACE procedure was accomplished in all patients,no serious or surgery-related death occurred. Except for serum albumin(ALB), the differences in pre-TACE and post-TACE total bilirubin(TBIL), aspartate aminotransferase(AST), alanine aminotransferase(ALT), white blood cell(WBC), red blood cell(RBC) and platelet(PLT) levels between the two groups were not statistically significant(P>0.05). The differences in the incidences of post-TACE one-week adverse reactions such as abdominal pain, fever, nausea, vomiting, etc., and in the post-TACE 6-month tumor response rates between the two groups were not statistically significant(P>0.05). Conclusion Regardless of having a previous TIPS treatment, TACE remains a safe and effective therapy for HCC patients.(J Intervent Radiol, 2021, 30:1052-1056)