TIPS+TACE治疗原发性肝癌并肝硬化门静脉高压性出血的疗效及安全性  

Efficacy and safety of TIPS+TACE in the treatment of primary hepatic carcinoma with cirrhotic portal hypertension and esophageal varices hemorrhage

作　　者：孙世蒙 雷振武[1] 李玉彪 黄君君 陈治远 洪磊 SUN Shimeng;LEI Zhenwu;LI Yubiao;HUANG Junjun;CHEN Zhiyuan;HONG Lei(Departmentof Interventional Therapy,the Affiliated Hospitalof Qinghai University,Xining 810001,China)

机构地区：[1]青海大学附属医院介入科,青海西宁810001

出　　处：《实用放射学杂志》2022年第5期826-830,共5页Journal of Practical Radiology

基　　金：青海大学中青年科研基金项目(2018-QYY-12);青海省卫生健康委员会重点科研基金项目(2018-wjzd-13).

摘　　要：目的探讨经颈静脉肝内门腔分流术(TIPS)联合经导管肝动脉灌注化疗栓塞术(TACE)治疗原发性肝癌(PHC)合并肝硬化门静脉高压(CPH)性食管静脉曲张破裂出血的安全性及疗效分析。方法回顾性分析PHC合并CPH性食管静脉曲张破裂出血临床资料,其中TIPS+TACE为观察组,TACE+内科治疗为对照组,比较2组术前、术后肝功能分级、肝脏血流动力学改变、肿瘤疗效及术后并发症。结果TIPS治疗成功率100%,即刻止血率100%,术前门静脉压力(41.35±6.69)cm H_(2)O,术后门静脉压力(27.28±5.46)cm H_(2)0,有统计学差异(P<0.05),术后6月、术后1年支架通畅率分别为100%、97.06%;2组患者肝功能Child-Pugh分级术后1月、3月、6月、1年比较有统计学差异(P<0.05);2组患者门静脉直径(PVD)、门静脉流速(PVV)、门静脉血流量(PVF)术后3月、6月、1年比较有统计学差异(P<0.05);2组患者再出血率、肝性脑病发生率术后6月比较有统计学差异(P<0.05),2组患者再出血率、腹水发生率、肝性脑病发生率术后1年比较有统计学差异(P<0.05)。结论TIPS+TACE治疗PHC合并CPH性食管静脉曲张破裂出血,有效降低门静脉压力,控制出血,改善患者肝功能,治疗效果确切,安全有效。Objective To investigate the safety and efficacy of transjugular intrahepatic portosystemic shunt(TIPS)combined with transcatheter arterial chemoembolization(TACE)in the treatment of primary hepatic carcinoma(PHC)with cirrhotic portal hypertension(CPH)and esophageal varices hemorrhage.Methods The clinical data of PHC with CPH and esophageal varices hemorrhage were analyzed retrospectively,and then the patients were divided into TIPS+TACE group and TACE+medical treatment group.The pre-and postoperative liver function grade,liver hemodynamic changes,tumor curative effect and postoperative complications between two groups were compared.Results Both the success rate of TIPS treatment and immediate hemostatic rate were 100%.The pre-and postoperative portal vein pressure were(41.35±6.69)cm H_(2)0 and(27.28±5.46)cm H_(2)O,exhibiting a statistical difference(P<0.05).The stent patency rate was 100%and 97.06%after 6 months and 1 year postoperatively,respectively.Between the two groups,the statistically significant differences were found in Child-Pugh classification of liver function at 1 month,3 months,6 months and 1 year,in portal vein diameter(PVD),portal vein velocity(PVV)and portal venous flow(PVF)at 3 months,6 months and 1 year,in the rate of rebleeding and the incidence of hepatic encephalopathy at 6 months,and in the rate of rebleeding,the incidence of ascites and the incidence of hepatic encephalopathy at 1 year after treatment(P<0.05).Conclusion TIPS+TACE can effectively reduce portal vein pressure,control bleeding and improve patients*liver function in the treatment of PHC with CPH and esophageal varices hemorrhage.The therapeutic effect is definite,safe and effective.

关 键 词：经颈静脉肝内门腔分流术 经导管肝动脉灌注化疗栓塞术 原发性肝癌 肝硬化门静脉高压 

分 类 号：R815[医药卫生—放射医学] R735.7[医药卫生—临床医学]