Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Red de Salud UC Christus; Hospital Dr. Sotero del Rio, Santiago, Chile.
United European Gastroenterol J. 2023 Oct;11(8):733-744. doi: 10.1002/ueg2.12454. Epub 2023 Sep 22.
BACKGROUND/AIMS: Transjugular intrahepatic portosystemic shunts (TIPS) in patients with hepatocellular carcinoma (HCC) may improve access to curative therapies, treat portal hypertension (PH)-related complications without worsening liver function, and increase overall survival. Data on the efficacy and safety of TIPS to treat PH complications in HCC patients, as well as the HCC treatment response, were evaluated.
Studies reporting efficacy in controlling bleeding/ascites or response to HCC therapy, safety, and survival in patients with HCC and TIPS were searched systematically on PubMed and Embase. An extraction of articles using predefined data fields and quality indicators was used.
We selected 19 studies and found 937 patients treated for ascites/bleeding and 177 evaluating HCC treatment response. Over half were under 5 cm and solitary lesions, and most studies included tumours with portal vein thrombosis. Regarding PH studies, TIPS resolved bleeding/ascites in >60% of patients, more effective for bleeding. There were no lethal complications reported and procedural bleeding occurred in <5%. Hepatic encephalopathy occurred in 15%-30% within three months. In the HCC treatment-response studies, major complication rates were low with no mortality. In the studies that evaluated the response to transarterial chemoembolization, complete response rate of patients with TIPS varied from 16% to 75%. Liver transplantation rate varied from 8% to 80%, with >40% rate in half of the studies.
In the published studies, TIPS is effective in treating PH complications in patients with HCC. Prospective studies on TIPS placement in patients with HCC are urgently needed to evaluate the efficacy and safety of TIPS in this setting.
背景/目的：经颈静脉肝内门体分流术（TIPS）可改善肝细胞癌（HCC）患者获得根治性治疗的机会，在不损害肝功能的情况下治疗门静脉高压（PH）相关并发症，并提高总生存率。本文旨在评估 TIPS 治疗 HCC 患者 PH 并发症的疗效和安全性，以及 HCC 治疗反应。
系统检索 PubMed 和 Embase 数据库中关于 TIPS 治疗 HCC 患者 PH 并发症的疗效（控制出血/腹水或 HCC 治疗反应）、安全性和生存率的研究，并使用预设的数据字段和质量指标进行文献提取。
共纳入 19 项研究，其中 937 例患者因腹水/出血接受 TIPS 治疗，177 例患者评估 HCC 治疗反应。超过一半的患者肿瘤直径<5cm 且为单发，大多数研究纳入的肿瘤均伴有门静脉血栓形成。对于 PH 相关研究，TIPS 治疗后>60%的患者出血/腹水得到缓解，对出血的疗效更为显著。研究中未报告致死性并发症，操作相关出血的发生率<5%。术后 3 个月内发生肝性脑病的比例为 15%-30%。在 HCC 治疗反应研究中，主要并发症发生率低，无死亡病例。在评估 TIPS 联合经动脉化疗栓塞（TACE）治疗反应的研究中，TIPS 治疗后患者完全缓解率为 16%-75%。肝移植率为 8%-80%，半数以上的研究中肝移植率>40%。
在已发表的研究中，TIPS 治疗 HCC 患者 PH 并发症的疗效确切。迫切需要开展前瞻性研究，以评估 TIPS 在该人群中的疗效和安全性。
