Qiu Bin, Li Kai, Dong Xiaoqun, Liu Fu-Quan
Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Rd., Yangfangdian, Haidian District, Beijing, 100038, China.
Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Cardiovasc Intervent Radiol. 2017 Sep;40(9):1372-1382. doi: 10.1007/s00270-017-1655-8. Epub 2017 May 9.
In patients with hepatocellular carcinoma (HCC), limited therapeutic options are available for portal hypertension resulted from portal vein tumor thrombus (PVTT). We aimed to determine safety and efficacy of TIPS for treatment of symptomatic portal hypertension in HCC with PVTT.
We evaluated clinical characteristics of 95 patients with HCC and PVTT out of 992 patients who underwent TIPS. The primary endpoints included success rate, procedural mortality, serious complications, decrease in portosystemic pressure gradient, and symptom relief. The secondary endpoints included recurrence of portal hypertension, overall survival, adverse events related to treatments for HCC, and quality of life measured by Karnofsky Performance Status Scale (KPS).
Success rate of TIPS was 95.8% (91/95), with procedural mortality of 1.1%. Serious complications related to TIPS procedure occurred in 2.1% (2/95) of patients. The symptoms of portal hypertension were well relieved. Variceal bleeding was successfully controlled and terminated in 100% of patients, with a recurrence rate of 39.2% in 12 months. Refractory ascites/hydrothorax was controlled partially or completely in 92.9% of patients during 1 month after TIPS, with a recurrence rate of 17.9% in 12 months. Survival rate at 6, 12, 24, and 36 months was 75.8, 52.7, 26.4, and 3.3%, respectively. No unexpected adverse event related to treatments for HCC was observed. The KPS score was 49 ± 4.5 and 63 ± 4.7 before and 1 month after TIPS, respectively (p < 0.001).
TIPS is a safe and efficacious treatment for symptomatic portal hypertension in HCC with PVTT.
在肝细胞癌（HCC）患者中，对于门静脉肿瘤血栓（PVTT）导致的门静脉高压，可用的治疗选择有限。我们旨在确定经颈静脉肝内门体分流术（TIPS）治疗HCC合并PVTT所致症状性门静脉高压的安全性和有效性。
我们评估了992例行TIPS的患者中95例HCC合并PVTT患者的临床特征。主要终点包括成功率、手术死亡率、严重并发症、门体压力梯度降低和症状缓解。次要终点包括门静脉高压复发、总生存期、与HCC治疗相关的不良事件以及通过卡诺夫斯基功能状态量表（KPS）测量的生活质量。
TIPS的成功率为95.8%（91/95），手术死亡率为1.1%。2.1%（2/95）的患者发生了与TIPS手术相关的严重并发症。门静脉高压症状得到很好缓解。100%的患者静脉曲张出血成功得到控制并停止，12个月时复发率为39.2%。难治性腹水/胸腔积液在TIPS术后1个月内92.9%的患者中得到部分或完全控制，12个月时复发率为17.9%。6、12、24和36个月时的生存率分别为75.8%、52.7%、26.4%和3.3%。未观察到与HCC治疗相关的意外不良事件。TIPS术前和术后1个月时KPS评分分别为49±4.5和63±4.7（p<0.001）。
TIPS是治疗HCC合并PVTT所致症状性门静脉高压的一种安全有效的方法。
