[1]侯昌龙,熊柏柱,许 军,等.经颈静脉肝内门体分流术治疗肝癌合并门静脉高压的临床价值 [J].介入放射学杂志,2023,32(04):320-325.
 HOU Changlong,XIONG Baizhu,XU Jun,et al.The clinical value of transjugular intrahepatic portosystemic shunt in the treatment of hepatocellular carcinoma complicated by portal hypertension[J].journal interventional radiology,2023,32(04):320-325.
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经颈静脉肝内门体分流术治疗肝癌合并门静脉高压的临床价值
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《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
32
期数:
2023年04
页码:
320-325
栏目:
血管介入
出版日期:
2023-05-02

文章信息/Info

Title:
The clinical value of transjugular intrahepatic portosystemic shunt in the treatment of hepatocellular carcinoma complicated by portal hypertension
作者:
侯昌龙 熊柏柱 许 军 周 磊 费一鹏 施长杲 朱先海 谢 韬
Author(s):
HOU Changlong XIONG Baizhu XU Jun ZHOU Lei FEI Yipeng SHI Changgao ZHU Xianhai XIE Tao.
Department of Intervention of West District, Affiliated First Hospital of University of Science and Technology of China, Hefei, Anhui Province 230031, China
关键词:
【关键词】 肝癌门静脉高压 经导管动脉化疗栓塞术 经颈静脉肝内门体分流术
文献标志码:
A
摘要:
【摘要】 选取2017年5月至2021年5月在中国科学技术大学附属第一医院接受TIPS治疗的肝癌合并PHT患者31例作为研究组,筛选接受保守治疗患者36例作为对照组。根据改良实体瘤疗效评价标准(mRECIST)评估患者疗效,比较两组并发症发生情况和无并发症生存时间。结果 TIPS手术成功率为100%。术后门静脉压力平均降低19.57 cmH2O(95%CI=17.88~21.26),门静脉直径平均缩小4.25 mm(95%CI=2.85~5.66),差异有统计学意义(t=23.672、6.178,均P<0.05)。术后1年支架畅通率为90%(28/31),2年畅通率为87%(27/31)。研究组、对照组治疗后1年内肝性脑病(HE)发生率差异无统计学意义[32%(10/31)、25%(9/36), χ2=0.432,P=0.510]。研究组HE患者12、20个月累积生存率和中位生存时间均高于对照组(78.8%、39.4%和 19个月比33.3%、0和8个月,均P<0.05)。研究组、对照组中位无并发症生存时间分别为153 d、58 d,30 d和90 d无并发症生存率分别为90.3%和61.3%,77.8%和30.6%,研究组优于对照组(均P<0.01)。研究组腹水、再出血发生率均低于对照组( χ2=16.810、15.085,均P<0.01)。研究组、对照组分别有19例、20例患者接受肝癌介入治疗,手术均获得成功。两组不良反应发生率和治疗3个月后肿瘤反应率差异无统计学意义(均P>0.05) 结论 TIPS治疗肝癌合并PHT具有一定的临床应用价值。

参考文献/References:

[1] Sung H,Ferlay J,Siegel RL,et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71: 209- 249.
[2] Harris PS,Hansen RM,Gray ME,et al. Hepatocellular carcinoma surveillance: an evidence- based approach[J]. World J Gastro- enterol, 2019, 25: 1550- 1559.
[3] Yan H,Wang G,Zhu W,et al. Feasibility and clinical value of TIPS combined with subsequent antitumor treatment in HCC patients with refractory ascites[J]. Transl Oncol, 2020, 13: 100864.
[4] Llovet JM,Kelley RK,Villanueva A,et al. Hepatocellular carcinoma[J]. Nat Rev Dis Primers, 2021, 7:6.
[5] Simonetto DA,Liu M,Kamath PS. Portal hypertension and related complications: diagnosis and management[J]. Mayo Clin Proc, 2019, 94: 714- 726.
[6] European Association for the Study of the Liver. EASL clinical practice guidelines:management of hepatocellular carcinoma[J]. J Hepatol, 2018, 69:182- 236.
[7] Reig M,Forner A,Rimola J,et al. BCLC strategy for prognosis prediction and treatment recommendation Barcelona Clinic Liver Cancer (BCLC) staging system. The 2022 update[J]. J Hepatol, 2021: 3- 6.
[8] Reig M,Forner A,Avila MA,et al. Diagnosis and treatment of hepatocellular carcinoma. Update of the consensus document of the AEEH,AEC,SEOM,SERAM,SERVEI,and SETH[J]. Med Clin(Barc), 2021, 156: 463.e1- e30.
[9] Zheng J,Feng X,Liang Y,et al. Safety and feasibility of laparoscopic liver resection for hepatocellular carcinoma with clinically significant portal hypertension: a propensity score- matched study[J]. Surg Endosc, 2021, 35: 3267- 3278.
[10] Liu J, Meng J, Zhou C, et al. A new choice of stent for transjugular intrahepatic portosystemic shunt creation: viabahn ePTFE covered stent/bare metal stent combination[J]. J Interv Med, 2021, 4: 32- 38.
[11] Qiu Z,Wang GS,Gao F.Whole- course management of interventional treatment in liver cancer patients with portal hypertension[J]. J Interv Med, 2019, 2:52- 54.
[12] Luo SH, Chu JG, Huang H, et al. Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma[J]. World J Clin Cases, 2019, 7: 1599- 1610.
[13] Chen X,Qiu ZK,Wang GB,et al. Effect of transjugular intrahepatic portosystemic shunt on transarterial chemoembolization for hepatocellular carcinoma: a systematic review and meta- analysis[J]. Diagn Interv Radiol, 2021, 27: 671- 676.
[14] Sternby EM, Hagstrom H, Mortensen K, et al. Quality of life as a prognostic factor for survival in hepatocellular carcinoma[J]. Liver Int, 2018, 38: 885- 894.
[15] Wang P,Qi X,Xu K. Evolution,progress,and prospects of research on transjugular intrahepatic portosystemic shunt applications[J]. J Interv Med, 2021, 4: 57- 61.
[16] Tripathi D,Stanley AJ,Hayes PC,et al. Transjugular intrahepatic portosystemic stent- shunt in the management of portal hypertension[J]. Gut, 2020, 69: 1173- 1192.
[17] Xu XY,Ding HG,Li WG,et al. Chinese guidelines on management of hepatic encephalopathy in cirrhosis[J]. World J Gastroenterol, 2019, 25: 5403- 5422.
[18] 杨 凯,张学贤,赵 卫,等. 经颈静脉肝内门体分流术后肝性脑病研究进展[J]. 介入放射学杂志, 2021, 30:1180- 1183.
[19] 刘 芳,赵剑波,王江云,等. 采用专用覆膜支架行经颈静脉肝内门体分流术2年随访观察[J]. 介入放射学杂志, 2021, 30:888- 892.
[20] Stankovic Z, Rossle M, Euringer W, et al. Effect of TIPS placement on portal and splanchnic arterial blood flow in 4- dimensional flow MRI[J]. Eur Radiol, 2015, 25: 2634- 2640.
[21] Ruohoniemi DM, Taslakian B, Aaltonen EA, et al. Comparative analysis of safety and efficacy of transarterial chemoembolization for the treatment of hepatocellular carcinoma in patients with and without pre- existing transjugular intrahepatic portosystemic shunts[J]. J Vasc Interv Radiol, 2020, 31: 409- 415.
[22] 徐文海,许 伟,祖茂衡,等. 经导管动脉化疗栓塞治疗经颈静脉肝内门体分流术后肝细胞癌临床应用评价[J]. 介入放射学杂志,2021, 30:1052- 1056.

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备注/Memo

备注/Memo:
(收稿日期:2022- 03- 04)
(本文编辑:边 佶)
更新日期/Last Update: 2023-04-29