Liu Zechuan, Lyu Tianshi, Yang Jinming, Xie Yong, Fan Siyuan, Song Li, Zou Yinghua, Wang Jian
Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, People's Republic of China.
Department of Vascular Interventional, Aerospace Central Hospital, Beijing, People's Republic of China.
J Hepatocell Carcinoma. 2025 Jan 14;12:29-41. doi: 10.2147/JHC.S491153. eCollection 2025.
Portal vein tumor thrombus (PVTT)-related severe symptomatic portal hypertension (SPH) leads to a poor prognosis in patients with advanced hepatocellular carcinoma (HCC). Traditional transjugular intrahepatic portosystemic shunt (TIPS) using covered plus bare stent can effectively relieve SPH, however, the bare segment is susceptible to obstruction due to PVTT invasion. This study aimed to evaluate the safety and efficacy of fully covered stent-TIPS (FCS-TIPS) for treatment of PVTT-related SPH in advanced HCC patients.
This retrospective study enrolled 25 patients with advanced HCC who underwent FCS-TIPS for PVTT-related severe SPH from June 2018 to January 2024. The evaluated outcomes included overall survival (OS), technical success rate, reduction in portal venous pressure gradient (PPG), stent patency rate, SPH control rate, liver function and complications.
The technical success rate was 100% without perioperative deaths or severe procedure-related adverse events. The average PPG decreased by 13.4±4.6 mmHg. The overall symptom control rate of SPH was 96.0%. Variceal bleeding, ascites/hydrothorax, and enteropathy control rates were 100%, 95.0%, and 100%, respectively. Liver function showed mild improvement one month after TIPS. One patient (4.0%) experienced overt hepatic encephalopathy (OHE) and three (12.0%) patients developed shunt dysfunction during the follow-up period. None of the patients experienced shunt-induced extrahepatic metastasis. The median OS was 6.0 months and the cumulative survival rates at 3, 6, 12 months were 80.0%, 52.0% and 21.3%.
FCS-TIPS is safe and effective for treating PVTT-related severe SPH and can serve as a bridging therapy for advanced HCC.
门静脉肿瘤血栓（PVTT）相关的严重症状性门静脉高压（SPH）导致晚期肝细胞癌（HCC）患者预后不良。使用覆膜加裸支架的传统经颈静脉肝内门体分流术（TIPS）可有效缓解SPH，然而，裸段易因PVTT侵犯而阻塞。本研究旨在评估全覆膜支架-TIPS（FCS-TIPS）治疗晚期HCC患者PVTT相关SPH的安全性和有效性。
本回顾性研究纳入了2018年6月至2024年1月期间因PVTT相关严重SPH接受FCS-TIPS治疗的25例晚期HCC患者。评估的结果包括总生存期（OS）、技术成功率、门静脉压力梯度（PPG）降低、支架通畅率、SPH控制率、肝功能和并发症。
技术成功率为100%，无围手术期死亡或严重的手术相关不良事件。平均PPG下降了13.4±4.6 mmHg。SPH的总体症状控制率为96.0%。静脉曲张出血、腹水/胸水和肠病控制率分别为100%、95.0%和100%。TIPS术后1个月肝功能有轻度改善。1例患者（4.0%）发生明显肝性脑病（OHE），3例患者（12.0%）在随访期间出现分流功能障碍。所有患者均未发生分流诱导的肝外转移。中位OS为6.0个月，3、6、12个月的累积生存率分别为80.0%、52.0%和21.3%。
FCS-TIPS治疗PVTT相关严重SPH安全有效，可作为晚期HCC的桥接治疗。
