肝细胞癌伴Vp4型门静脉瘤栓患者行挽救性TIPS的安全性及有效性研究  

Safety and effectiveness of salvage transjugular intrahepatic portosystemic shunt for hepatocellular carcinoma with Vp4 portal vein tumor thrombus

作　　者：江晴贵 吕天石[1] 姚航 武思彤 宋莉[1] 佟小强[1] 李槐 邹英华[1] 王健[1] Jiang Qinggui;Lyu Tianshi;Yao Hang;Wu Sitong;Song Li;Tong Xiaoqiang;Li Huai;Zou Yinghua;Wang Jian(Department of Interventional Radiology and Vascular Surgery,Peking University First Hospital,Beijing 100034,China;Department of Tumor and Vascular Interventional Therapy,Xiamen Humanity Hospital,Xiamen 361000,China)

机构地区：[1]北京大学第一医院介入血管外科,北京100034 [2]厦门弘爱医院肿瘤与血管介入治疗科,厦门361000

出　　处：《中华肝胆外科杂志》2023年第10期727-731,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：中央高水平医院临床科研业务费资助项目(2022CR57)。

摘　　要：目的探讨肝细胞癌伴Vp4型门静脉瘤栓患者行经颈静脉肝内门体分流术(TIPS)的安全性和有效性。方法回顾性分析2018年7月至2023年2月在北京大学第一医院行TIPS治疗的15例肝细胞癌伴Vp4型瘤栓合并门静脉高压并发症患者的资料,其中男性14例,女性1例,年龄(61.5±11.1)岁,年龄范围40~78岁。记录TIPS手术成功率、手术前后门静脉压力梯度(PPG),观察围手术期不良反应及并发症。术后通过电话随访患者的生存状态。以Kaplan-Meier法绘制生存曲线,计算累积生存率。结果所有患者均成功实施TIPS手术,技术成功率为100%(15/15)。手术前后的PPG分别为(31.73±5.48)mmHg(1 mmHg=0.133 kPa)和(17.60±3.66)mmHg,差异具有统计学意义(P<0.001)。15例均未出现围手术期死亡,未见肝动脉/胆管损伤、急性肝功能衰竭等并发症。与TIPS术前相比,患者TIPS术后1个月的体力状态评分[0(0,0)分比3(3,3)分]和Child-Pugh评分[6(5,8)分比9(8,10)分]均降低,差异均具有统计学意义(均P<0.05)。本组患者术后中位生存时间为228 d。Kaplan-Meier曲线显示,术后3、6、12、24个月的累积生存率分别为100%、64.3%、32.7%、8.2%。结论 TIPS治疗肝细胞癌伴Vp4型瘤栓合并门静脉高压严重并发症的患者安全、有效。Objective To evaluate the safety and effectiveness of transjugular intrahepatic portosystemic shunt(TIPS)in hepatocellular carcinoma(HCC)patients with Vp4 portal vein tumor thrombus(PVTT).Methods Data of 15 patients undergoing TIPS for HCC with Vp4 PVTT and portal hypertension(PTN)in Peking University First Hospital from July 2018 to February 2023 were retrospectively analyzed,including 14 males and 1 female,aged(61.5±11.1)years old,ranging from 40 to 78 years old.The success rate of TIPS,portal pressure gradient(PPG)before and after procedure,perioperative adverse effects and complications were recorded.The survival status of patients was followed up by telephone review after surgery.Kaplan-Meier method was used for survival analysis.Results The procedure of TIPS was performed uneventfully in all patients,with a technical success rate of 100%(15/15).PPG before and after TIPS were(31.73±5.48)mmHg(1 mmHg=0.133 kPa)and(17.60±3.66)mmHg,respectively,and the difference was statistically significant(P<0.001).No perioperative death,hepatic artery or bile duct injury,acute liver failure or other major complications occurred.Compared with the preoperative status,the performance status scores[0(0,0)vs.3(3,3)]and Child-Pugh scores[6(5,8)vs.9(8,10)]were lower in patients one month after TIPS(all P<0.05).The median survival time was 228 d.Kaplan-Meier curves showed that the cumulative survival rates at 3,6,12 and 24 months after TIPS were 100%,64.3%,32.7%and 8.2%,respectively.Conclusion TIPS could be safe and effective for HCC with Vp4 PVTT and severe PTN.

关 键 词：癌 肝细胞 门静脉癌栓 门静脉高压 经颈静脉肝内门体分流术 

分 类 号：R735.7[医药卫生—肿瘤]