Zhang Yue, Wu Yi-Fan, Yue Zhen-Dong, Zhao Hong-Wei, Wang Lei, Fan Zhen-Hua, He Fu-Liang, Wang Tao, Liu Fu-Quan
Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China.
Department of Interventional Therapy, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China.
World J Gastrointest Oncol. 2019 Apr 15;11(4):310-321. doi: 10.4251/wjgo.v11.i4.310.
Main portal vein tumor thrombus (MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma (HCC). Therefore, attention should be paid to the treatment of MPVTT and its complications.
To evaluate the efficacy of transarterial chemoembolization/transarterial embolization (TACE/TAE)+I seeds implantation with transjugular intrahepatic portosystemic shunt (TIPS) in treating MPVTT and its complications.
From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and I implantation (TIPS-I group) or TACE/TAE + TIPS only (TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-I.
During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-I group, whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively ( < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%, respectively, in the TIPS-I group, whereas those in the TIPS only group were 31.1%, 62.2%, and 82.2% ( < 0.05). The rates of stent restenosis were 12.5%, 27.5%, and 42.5%, respectively, in the TIPS-I group, and 42.2%, 68.9%, and 84.4%, respectively, in the TIPS only group ( < 0.05). TIPS-I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.
TACE/TAE+I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.
门静脉主干癌栓（MPVTT）发病率较高，是晚期肝癌的主要并发症。MPVTT的发生一直是肝细胞癌（HCC）患者的不良预后因素。因此，应重视MPVTT及其并发症的治疗。
评价经动脉化疗栓塞/经动脉栓塞（TACE/TAE）联合碘粒子植入与经颈静脉肝内门体分流术（TIPS）治疗MPVTT及其并发症的疗效。
2007年1月至2015年3月，北京世纪坛医院连续85例MPVTT患者非随机分组，分别接受TACE/TAE+TIPS联合碘粒子植入治疗（TIPS-I组）或单纯TACE/TAE+TIPS治疗（单纯TIPS组），并收集所有临床资料。在24个月的随访期间，分析总生存率、支架狭窄率和症状复发率，以评估TIPS-I的疗效。
在对所有患者进行24个月的随访期间，我们在6、12和24个月时收集了数据。TIPS-I组的生存率分别为80%、45%和20%，而单纯TIPS组的生存率分别为64.4%、24.4%和4.4%（P<0.05）。TIPS-I组症状复发率分别为7.5%、22.5%和35%，而单纯TIPS组分别为31.1%、62.2%和82.2%（P<0.05）。TIPS-I组支架再狭窄率分别为12.5%、27.5%和42.5%，单纯TIPS组分别为42.2%、68.9%和84.4%（P<0.05）。结果发现，TIPS-I在治疗HCC患者的MPVTT及其并发症方面具有显著优势。
TACE/TAE联合碘粒子植入与TIPS治疗MPVTT及其并发症有效，可提高患者生活质量，降低死亡率。
