Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
National Clinical Research Center for Digestive Diseases, State Key Laboratory of Cancer Biology and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China.
J Vasc Interv Radiol. 2021 Jul;32(7):963-969. doi: 10.1016/j.jvir.2021.04.005. Epub 2021 Apr 20.
To evaluate the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) creation for the prevention of gastric variceal rebleeding in patients with hepatocellular carcinoma (HCC).
This multicenter retrospective study included 126 cirrhotic patients (mean age, 54.1 ± 10.2 years; 110 men) with HCC who underwent TIPS creation for the prevention of gastric variceal rebleeding. Of these, 110 (87.3%) patients had gastroesophageal varices and 16 (12.7%) patients had isolated gastric varices. Thirty-five (27.8%) patients had portal vein tumor thrombus.
TIPS creation was technically successful in 124 (98.4%) patients. Rebleeding occurred in 26 (20.6%) patients during the follow-up period. The 6-week and 1-year actuarial probabilities of patients remaining free of rebleeding were 98.3% ± 1.2% and 81.2% ± 3.9%, respectively. Forty-nine (38.8%) patients died during the follow-up period. The 6-week and 1-year actuarial probabilities of survival were 98.4 ± 1.1% and 65.6 ± 4.4%, respectively. Two (1.6%) patients had major procedure-related complications, including acute liver failure (n = 1) and intra-abdominal bleeding (n = 1). Thirty-three (26.2%) patients had at least 1 episode of overt hepatic encephalopathy during the follow-up period. Shunt dysfunction occurred in 15 (11.9%) patients after a median follow-up time of 11.4 months (range, 1.4-41.3 months). Lung metastasis occurred in 3 (2.4%) patients, 3.9-32.9 months after TIPS creation.
TIPS creation may be effective and safe for the prevention of gastric variceal rebleeding in patients with HCC.
评估经颈静脉肝内门体分流术（TIPS）创建用于预防肝细胞癌（HCC）患者胃静脉曲张再出血的有效性和安全性。
这项多中心回顾性研究纳入了 126 例因预防胃静脉曲张再出血而行 TIPS 创建的肝硬化 HCC 患者（平均年龄 54.1±10.2 岁；110 例男性）。其中 110 例（87.3%）患者存在胃食管静脉曲张，16 例（12.7%）患者存在孤立性胃静脉曲张。35 例（27.8%）患者存在门静脉癌栓。
124 例（98.4%）患者 TIPS 创建技术成功。随访期间 26 例（20.6%）患者再出血。6 周和 1 年无再出血累积生存率分别为 98.3%±1.2%和 81.2%±3.9%。49 例（38.8%）患者在随访期间死亡。6 周和 1 年累积生存率分别为 98.4%±1.1%和 65.6%±4.4%。2 例（1.6%）患者发生严重与操作相关的并发症，包括急性肝功能衰竭（n=1）和腹腔内出血（n=1）。33 例（26.2%）患者在随访期间至少发生 1 次显性肝性脑病。中位随访时间为 11.4 个月（范围 1.4-41.3 个月）后，15 例（11.9%）患者出现分流道功能障碍。TIPS 创建后 3.9-32.9 个月，3 例（2.4%）患者发生肺转移。
TIPS 创建可能对预防 HCC 患者胃静脉曲张再出血有效且安全。
