肝细胞癌伴严重门静脉高压并发症行TIPS治疗的安全性

Safety of TIPS for treating hepatocellular carcinoma complicated with server portal hypertension complication

目的观察TIPS治疗巴塞罗那临床肝癌(BCLC)D期肝细胞癌(HCC)伴严重门静脉高压并发症的安全性。方法纳入24例BCLC D期HCC伴严重门静脉高压并发症患者,观察TIPS及其后随访资料,分析TIPS技术成功率、门静脉压力梯度(PPG)变化、门静脉高压并发症缓解率、BCLD情况、并发症及死亡率等,评估其疗效。结果TIPS技术成功率100%。TIPS前、后PPG分别为(32.13±6.93)mmHg及(18.75±5.05)mmHg,TIPS后PPG降低(t=12.604,P<0.001)。TIPS后次日,1例因支架内癌栓及血栓致支架急性闭塞,予补充性植入1枚覆膜支架后血流恢复;TIPS后2周门静脉高压并发症缓解率100%,未见相关并发症及死亡。TIPS前及1个月后患者体力状况(PS)评分分别为3.08±0.28及1.97±1.01;肝功能Child-Pugh评分分别为7.50±1.79及5.71±2.22,差异均有统计学意义(t=6.273、5.033,P均<0.001)。TIPS后1个月,HCC BCLC C期15例、B期4例、A期3例,与TIPS前差异有统计学意义(χ^(2)=13.565,P<0.001);2例死于多器官功能衰竭。TIPS后3个月2例发生Ⅲ级肝性脑病,均经对症处理后缓解;支架分流道通畅率及门静脉高压并发症缓解率均为100%。结论TIPS治疗BCLC D期HCC伴严重门静脉高压并发症安全、有效。

Objective To observe the safety of TIPS for treating hepatocellular carcinoma(HCC)of Barcelona clinic liver cancer(BCLC)stage D complicated with severe portal hypertension complications.Methods Totally 24 patients with HCC of BCLC stage D complicated with severe portal hypertension complications were enrolled.Data of TIPS procedures and follow-up were observed,and the success rate of TIPS technology,changes of portal venous pressure gradient(PPG),remission rate of portal hypertension complications,BCLD stage,as well as complications and mortality rate were analyzed,and the therapeutic effect of TIPS was evaluated.Results The success rate of TIPS technology was 100%.PPG before and after TIPS was(32.13±6.93)mmHg and(18.75±5.05)mmHg,respectively,which decreased obviously after TIPS(t=12.604,P<0.001).On the next day of TIPS,acute stent occlusion occurred in 1 case due to tumor embolus and thrombus in stent,then blood flow recovered after supplementary implantation of 1 covered stent.Two weeks after TIPS,the remission rate of portal hypertension complications was 100%,no related complications nor death.Patients'performance status(PS)score was 3.08±0.28 and 1.97±1.01 before and 1 month after TIPS,respectively,while Child-Pugh score of liver function was 7.50±1.79 and 5.71±2.22,respectively,both being significantly different(t=6.273,5.033,both P<0.001).One month after TIPS,there were 15 cases of BCLC stage C,4 cases of stage B,and 3 cases of stage A,being significantly different compared with those before TIPS(χ^(2)=13.565,P<0.001),while 2 cases died of multiple organs failure.Three months after TIPS,grade Ⅲ hepatic encephalopathy occurred in 2 cases but alleviated after symptomatic treatments,and the patency rate of stent shunt and remission rate of portal hypertension complications were both 100%.Conclusion TIPS was safe and effective for treating HCC of BCLD stage D complicated with severe portal hypertension complications.