Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751 024, India.
Department of Gastroenterology, King Edward Memorial Hospital and Seth G S Medical College, Mumbai, 400 012, India.
Indian J Gastroenterol. 2024 Dec;43(6):1121-1135. doi: 10.1007/s12664-024-01646-7. Epub 2024 Aug 10.
Patients with hepatocellular carcinoma (HCC) and cirrhosis can present with features of severe portal hypertension, which can be worsened further by portal vein tumoral thrombosis (PVTT). Due to the technical difficulties and short survival of these patients, HCC was traditionally considered a relative contra-indication for transjugular intrahepatic portosystemic shunt (TIPS). However, there is an increasing body of evidence, mainly from China, supporting the use of TIPS in HCC. The present study aimed at analyzing the efficacy and safety of TIPS in patients with HCC.
From 2000 through May 2023, MEDLINE, Embase and Scopus were searched for studies analyzing the outcome of TIPS in HCC. Technical and clinical success, adverse events (AE) and mortality were the main outcomes assessed. With the use of a random effects model, the event rates were combined.
Total 19 studies with 1498 patients were included in the final analysis. The pooled technical and clinical success rates with TIPS in HCC were 98.8% (98.0-99.7) and 94.1% (91.2-97.0), respectively. After TIPS, ascites was controlled in 89.2% (85.1-93.3) of the cases, while rebleeding was observed in 17.2% (9.4-25.0) of cases on follow-up. The pooled incidence of overall AE, serious AE and post-TIPS hepatic encephalopathy (HE) was 5.2% (2.5-7.9), 0.1% (0.0-0.4) and 25.1% (18.7-31.5), respectively. On follow-up, 11.9% (7.8-15.9) of the patients developed shunt dysfunction requiring re-intervention.
The present analysis supports the feasibility, safety and efficacy of TIPS in the management of portal hypertension in patients with HCC.
肝细胞癌（HCC）和肝硬化患者可能出现严重门静脉高压的特征，门静脉肿瘤血栓形成（PVTT）可进一步加重门静脉高压。由于这些患者的技术难度和生存时间短，HCC 传统上被认为是经颈静脉肝内门体分流术（TIPS）的相对禁忌症。然而，越来越多的证据主要来自中国，支持 TIPS 在 HCC 中的应用。本研究旨在分析 TIPS 在 HCC 患者中的疗效和安全性。
从 2000 年到 2023 年 5 月，我们检索了 MEDLINE、Embase 和 Scopus 数据库，以分析 TIPS 治疗 HCC 的研究结果。主要评估的终点为技术和临床成功率、不良事件（AE）和死亡率。使用随机效应模型，组合事件发生率。
最终分析纳入了 19 项研究共 1498 例患者。TIPS 治疗 HCC 的总体技术和临床成功率分别为 98.8%（98.0-99.7）和 94.1%（91.2-97.0）。TIPS 后，89.2%（85.1-93.3）的病例腹水得到控制，而随访中 17.2%（9.4-25.0）的病例出现再出血。总体 AE、严重 AE 和 TIPS 后肝性脑病（HE）的发生率分别为 5.2%（2.5-7.9）、0.1%（0.0-0.4）和 25.1%（18.7-31.5）。随访中，11.9%（7.8-15.9）的患者出现需要再次介入的分流功能障碍。
本分析支持 TIPS 在 HCC 患者门静脉高压管理中的可行性、安全性和疗效。
