Weng X T, Li L, Huang X H, Guo X, Lei X J, Jiao Y B, Lin F, Ke Q, Guo W H
Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China.
Department of Interventional Radiology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.
Zhonghua Gan Zang Bing Za Zhi. 2022 Jun 20;30(6):618-623. doi: 10.3760/cma.j.cn501113-20210820-00415.
To study the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with iodine-125 (Ⅰ) seed strands implantation in patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. 25 cases with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ requiring TIPS were simultaneously implanted with Ⅰseed strand. Tumor thrombus was controlled with I seed implantation brachytherapy to keep the TIPS pathway unobstructed, reduce the portal vein pressure, and observe the changes in the cause of death of the patients. During the same period, 30 cases without TIPS and seed strand implantation were used as controls. Data between groups were compared using -test, Chi-Squared test or Fisher's exact test. TIPS combined with Ⅰ seed strand implantation was safe in patients with diffuse hepatocellular carcinoma combined with type III/IV portal vein tumor thrombus, and 92.0% (23/25) of the patients maintained unobstructed TIPS pathway. Compared with the control group, patients in the treatment group died of fewer lead-related complications, and most died from chronic liver failure (84.0% 56.7%, = 4.771, =0.029). The incidence of upper gastrointestinal bleeding was significantly decreased (12.0% vs. 46.7%, =7.674, =0.006) and ascites severity was significantly improved (mild 40.0% 16.7%, moderate 52.0% 20.0%, severe 8.0% 46.7%, =13.246 , =0.001). TIPS combined with Ⅰ seed strand implantation is safe and feasible in patients with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ. Moreover, it can effectively keep the shunt patency and reduce portal vein pressure, thereby reducing the incidence of upper gastrointestinal bleeding and improving the degree of ascites. TIPS combined with Ⅰ seed strand implantation may be used as a standard treatment modality for patients requiring TIPS therapy combined with tumor thrombus type Ⅲ/Ⅳ.
研究经颈静脉肝内门体分流术（TIPS）联合碘-125（Ⅰ）粒子条植入术治疗肝细胞癌合并门静脉癌栓患者的安全性和疗效。选取25例肝内弥漫性肿瘤合并Ⅲ/Ⅳ型癌栓且需行TIPS治疗的患者，同时植入Ⅰ粒子条。采用碘粒子植入近距离放疗控制癌栓，保持TIPS通路通畅，降低门静脉压力，观察患者死因变化。同期选取30例未行TIPS及粒子条植入的患者作为对照。组间数据比较采用t检验、卡方检验或Fisher确切概率法。TIPS联合Ⅰ粒子条植入术应用于肝内弥漫性肝细胞癌合并Ⅲ/Ⅳ型门静脉癌栓患者是安全的，92.0%（23/25）的患者TIPS通路保持通畅。与对照组相比，治疗组患者死于与引流相关并发症的较少，多数死于慢性肝衰竭（84.0%比56.7%，χ² = 4.771，P = 0.029）。上消化道出血发生率显著降低（12.0%比46.7%，χ² = 7.674，P = 0.006），腹水严重程度显著改善（轻度：40.0%比16.7%，中度：52.0%比20.0%，重度：8.0%比46.7%，χ² = 13.246，P = 0.001）。TIPS联合Ⅰ粒子条植入术应用于肝内弥漫性肿瘤合并Ⅲ/Ⅳ型癌栓患者安全可行。此外，其可有效保持分流道通畅，降低门静脉压力，从而降低上消化道出血发生率，改善腹水程度。TIPS联合Ⅰ粒子条植入术可作为需行TIPS治疗合并Ⅲ/Ⅳ型癌栓患者的标准治疗方式。
