多次TACE联合TIPS治疗肝癌合并肝硬化上消化道出血的临床效果

Clinical Efficacy of Repeated TACE Combined with TIPS in Treatment of Patients with Hepatocellular Carcinoma Complicated by Liver Cirrhosis and Upper Gastrointestinal Bleeding

目的评价多次经肝动脉化疗栓塞术(TACE)联合经颈内静脉肝内门-体分流术(TIPS)治疗肝癌合并肝硬化上消化道出血的安全性及有效性。方法回顾性分析2015年1月—2020年1月30例行多次TACE联合TIPS治疗肝癌合并肝硬化上消化道出血的临床资料。观察TACE治疗前后肝功能变化及并发症发生情况,同时观察其治疗效果及生存率。结果TIPS术后门静脉压力由术前的(37.58±7.26)mmHg降至术后的(23.35±6.47)mmHg,差异有统计学意义(P<0.05)。30例TIPS术后共行TACE治疗85次,其中完全缓解5例,部分缓解6例,疾病稳定14例,疾病进展5例;随访6、12和24个月生存率分别为93.3%、83.3%和67.7%。TACE治疗后1周丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)较治疗前升高,差异有统计学意义(P<0.05),治疗后2周和1个月AST及ALT与治疗前比较差异无统计学意义(P>0.05)。TACE治疗前后总胆红素及白蛋白比较差异无统计学意义(P>0.05)。每次TACE治疗后1个月肝功能比较差异无统计学意义(P>0.05)。所有患者均未出现严重并发症。结论多次TACE联合TIPS治疗肝癌合并肝硬化上消化道出血安全有效。

Objective To evaluate the safety and effectiveness of repeated transhepatic arterial chemoembolization(TACE)combined with transjugular intrahepatic portosystemic stent-shunt(TIPSS)in treatment of patients with hepatocellular carcinoma complicated by liver cirrhosis and upper gastrointestinal bleeding.Methods Clinical data of 30 patients with hepatocellular carcinoma complicated by liver cirrhosis and upper gastrointestinal bleeding who had received repeated TACE combined with TIPS between January 2015 and January 2020 was retrospectively analyzed.Changed of liver function and incidence rate of complications were compared before and after TACE,and curative efficacy and survival rate were also observed simultaneously.Results The portal vein pressure decreased from(37.58±7.26)mmHg before operation to(23.35±6.47)mmHg after TIPS,and the difference was statistically significant(P<0.05).TACE was performed for 85 times after TIPS in the 30 patients,and there were 5 patients with complete remission,6 with partial remission,14 with stable disease and 5 with disease progression.Survival rates with follow-up for 6-month,12-month and 24-month were 93.3%,83.3%and 67.7%respectively.After TACE for one week,levels of alanine transarninase(ALT)and aspartate aminotransferase(AST)were significantly higher than those before operation(P<0.05).There were no significant differences in AST and ALT levels before treatment with after treatment for 2 weeks and 1 month(P>0.05).There was no statistically significant difference in the liver function after each TACE procedure for 1 month(P>0.05).No serious complications were reported in all patients.Conclusion Repeated TACE combined with TIPSS in treatment of patients with hepatocellular carcinoma complicated by liver cirrhosis and upper gastrointestinal bleeding is safe and effective.