Safety and efficacy of transjugular intrahepatic portosystemic shunt combined with palliative treatment in patients with hepatocellular carcinoma  

作　　者：Shi-Hua Luo Jian-Guo Chu He Huang Ke-Chun Yao 

机构地区：[1]Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei Province, China [2]Department of Radiology, Air Force Medical Center of PLA, Beijing 100142, China [3]Department of Ultrasound, Air Force Medical Center of PLA, Beijing 100142, China

出　　处：《World Journal of Clinical Cases》2019年第13期1599-1610,共12页世界临床病例杂志

摘　　要：BACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma(HCC).Transjugular intrahepatic portosystemic shunt(TIPS)has good clinical effect in treating the complication of portal hypertension.However,because of the risk of postoperative liver failure,severe complications,and low survival rate for HCC,TIPS is contraindicated in patients with portal hypertension and liver cancer.We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites.AIM To assess the safety,efficacy,and survival rate in patients with HCC who underwent TIPS.ME THODS Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014.After TIPS deployment,these patients received palliative treatment for HCC.Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement.Group B received palliative treatment for HCC plus medical therapy for portal hypertension.The clinical outcomes and survival rate were assessed.RES UL TS In Group A,the primary technical success rate was 97.69%for TIPS placement,and no severe procedure-related complications of TIPS placement were reported.The control of variceal bleeding(VB)within 1 mo did not differ significantly between the groups(P=0.261).Absorption of refractory ascites within 1 mo,recurrence of VB,and recurrence of refractory ascites differed significantly between the groups(P=0.017,0.023,and 0.009,respectively).By comparison,the rate of hepatic encephalopathy in Group B was lower than that in Group A(P=0.036).The 1-,2-,3-,4-,and 5-year survival rates were significantly different between Groups A and B(X2=12.227,P=0.018;X2=12.457,P=0.014;X2=26.490,P=0.013;X2=21.956,P=0.009,and X2=24.596,P=0.006,respectively).The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B.Median survival time was 50.0 mo in Group A and 33.0 mo in Group B.Mean and median survival differed significantly between the two groups(P=0.000,XBACKGROUND There is a close relationship between cirrhosis and hepatocellular carcinoma (HCC). Transjugular intrahepatic portosystemic shunt (TIPS) has good clinical effect in treating the complication of portal hypertension. However, because of the risk of postoperative liver failure, severe complications, and low survival rate for HCC, TIPS is contraindicated in patients with portal hypertension and liver cancer. We studied a large cohort of patients with cirrhosis and HCC who underwent TIPS for recurrent variceal bleeding and/or ascites. AIM To assess the safety, efficacy, and survival rate in patients with HCC who underwent TIPS. METHODS Group A comprised 217 patients with HCC and portal hypertension who underwent the TIPS procedure between 1999 and 2014. After TIPS deployment, these patients received palliative treatment for HCC. Group B comprised a cohort of 136 HCC patients with portal hypertension who did not undergo TIPS placement. Group B received palliative treatment for HCC plus medical therapy for portal hypertension. The clinical outcomes and survival rate were assessed. RESULTS In Group A, the primary technical success rate was 97.69% for TIPS placement,and no severe procedure-related complications of TIPS placement were reported. The control of variceal bleeding (VB) within 1 mo did not differ significantly between the groups (P = 0.261). Absorption of refractory ascites within 1 mo, recurrence of VB, and recurrence of refractory ascites differed significantly between the groups (P = 0.017, 0.023, and 0.009, respectively). By comparison, the rate of hepatic encephalopathy in Group B was lower than that in Group A (P = 0.036). The 1-, 2-, 3-, 4-, and 5-year survival rates were significantly different between Groups A and B (χ^2 = 12.227, P = 0.018;χ^2 = 12.457, P = 0.014;χ^2 = 26.490, P = 0.013;χ^2 = 21.956, P = 0.009, and χ^2 = 24.596, P = 0.006, respectively). The mean survival time was 43.7 mo in Group A and 31.8 mo in Group B. Median survival time was 50.0 mo in Group A and 33.0 mo in Grou

关 键 词：HEPATOCELLULAR carcinoma PORTAL hypertension Transjugular INTRAHEPATIC portosystemic SHUNT Transarterial CHEMOEMBOLIZATION RADIOFREQUENCY ablation 

分 类 号：R[医药卫生]