Dai Feng, Pan Chunhan, Xu Chunyang, Yao Yu, Su Mu, Ren Jianwu, Qiu Zhiyuan, Capasso Mario, Zhang Xiuming
Department of Interventional Radiology, The Second Hospital of Nanjing, Affiliated to Nanjing University of Chinese Medicine, Nanjing, China.
Department of Radiology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
J Gastrointest Oncol. 2025 Aug 30;16(4):1648-1657. doi: 10.21037/jgo-2025-365. Epub 2025 Aug 27.
Portal hypertension (PHT) and hepatocellular carcinoma (HCC) often appear concurrently in clinic, and PHT variceal bleeding arising due to systemic treatment of HCC remains a clinical issue that urgently requires a solution. This study aimed to examine the therapeutic effects and clinical significance of transjugular intrahepatic portosystemic shunting (TIPS) in patients with HCC complicated with PHT.
In this retrospective study, 21 patients with HCC complicated with PHT who were admitted to The Second Hospital of Nanjing between June 2018 and June 2023 were included. TIPS was performed, and liver and kidney function, blood routine, and biochemical indicators such as ammonia were examined preoperatively, at 1 week postoperatively, and at 1 month postoperatively. To determine the improvements in stent blood flow, ascites, and esophageal and gastric varices, ultrasound and/or enhanced computed tomography were performed. Treatment was evaluated based on the Modified Solid Tumor Efficacy Evaluation Criteria. Parameters such as portal vein pressure and portal blood flow before and after TIPS were analyzed using paired-sample -tests.
Postoperatively, the direct pressure of the portal vein of patients decreased significantly from 28.33±7.15 to 19.27±3.10 mmHg (P<0.05). The amount of ascites also significantly decreased, whereas esophageal and gastric varicose veins significantly improved. Meanwhile, no significant differences were observed in liver or kidney function indicators, including bilirubin, transaminase, and creatinine, from the preoperative to the postoperative period.
TIPS can effectively improve the various symptoms of PHT without increasing the incidence of liver function damage or other complications in patients with HCC complicated with PHT.
门静脉高压（PHT）和肝细胞癌（HCC）在临床上常同时出现，因HCC全身治疗引发的PHT静脉曲张出血仍是一个亟待解决的临床问题。本研究旨在探讨经颈静脉肝内门体分流术（TIPS）对HCC合并PHT患者的治疗效果及临床意义。
本回顾性研究纳入了2018年6月至2023年6月期间在南京医科大学第二附属医院住院的21例HCC合并PHT患者。实施TIPS手术，并在术前、术后1周和术后1个月检查肝肾功能、血常规以及血氨等生化指标。为确定支架血流、腹水以及食管和胃静脉曲张的改善情况，进行了超声和/或增强计算机断层扫描。根据改良实体瘤疗效评价标准对治疗进行评估。使用配对样本t检验分析TIPS前后门静脉压力和门静脉血流等参数。
术后，患者门静脉直接压力从28.33±7.15显著降至19.27±3.10 mmHg（P<0.05）。腹水量也显著减少，而食管和胃静脉曲张明显改善。同时，从术前到术后，包括胆红素、转氨酶和肌酐在内的肝肾功能指标均未观察到显著差异。
TIPS可有效改善HCC合并PHT患者的PHT各种症状，且不会增加肝功能损害或其他并发症的发生率。
