Transjugular Intrahepatic Portosystemic Shunt Creation for the Prevention of Gastric Variceal Rebleeding in Patients with Hepatocellular Carcinoma: A Multicenter Retrospective Study
Transjugular Intrahepatic Portosystemic Shunt Creation for the Prevention of Gastric Variceal Rebleeding in Patients with Hepatocellular Carcinoma: A Multicenter Retrospective Study
复制标题
经颈静脉肝内门体分流术预防肝细胞癌患者胃静脉曲张再出血：一项多中心回顾性研究
DOI：
10.1016/j.jvir.2021.03.526
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发表时间：
2021-06-28
影响因子：
2.9
通讯作者：
Ahn, Sun Ho
中科院分区：
文献类型：
--
作者：
Park, Lauren S.;Dibble, Elizabeth H.;Ahn, Sun Ho
目的：目的探讨经颈静脉肝内门体分流术（TIPS）预防肝癌患者胃底静脉曲张再出血的有效性和安全性。材料与方法：这项多中心回顾性研究纳入了126例接受TIPS预防胃静脉曲张再出血的HCC患者（平均年龄54.1 ± 10.2岁; 110例男性）。其中，110例（87.3%）患者有胃食管静脉曲张，16例（12.7%）患者有孤立性胃静脉曲张。35例（27.8%）患者存在门静脉癌栓。结果：124例（98.4%）患者的TIPS创建技术成功。随访期间，26例（20.6%）患者发生再出血。患者保持无再出血的6周和1年精算概率分别为98.3% +/- 1.2%和81.2% +/-3.9%。49例（38.8%）患者在随访期间死亡。6周和1年生存率分别为98.4 +/- 1.1%和65.6 +/-4.4%。2例（1.6%）患者发生了重大手术相关并发症，包括急性肝衰竭（n = 1）和腹腔内出血（n = 1）。33例（26.2%）患者在随访期间至少发生1次明显的肝性脑病。中位随访时间为11.4个月（范围：1.4-41.3个月）后，15例（11.9%）患者发生分流功能障碍。3例（2.4%）患者在TIPS创建后3.9-32.9个月发生肺转移。结论：TIPS术是预防肝癌患者胃底静脉曲张再出血的一种安全有效的方法。
Purpose: To evaluate the effectiveness and safety of transjugular intrahepatic portosystemic shunt (TIPS) creation for the prevention of gastric variceal rebleeding in patients with hepatocellular carcinoma (HCC). Materials and Methods: This multicenter retrospective study included 126 cirrhotic patients (mean age, 54.1 +/- 10.2 years; 110 men) with HCC who underwent TIPS creation for the prevention of gastric variceal rebleeding. Of these, 110 (87.3%) patients had gastroesophageal varices and 16 (12.7%) patients had isolated gastric varices. Thirty-five (27.8%) patients had portal vein tumor thrombus. Results: TIPS creation was technically successful in 124 (98.4%) patients. Rebleeding occurred in 26 (20.6%) patients during the follow-up period. The 6-week and 1-year actuarial probabilities of patients remaining free of rebleeding were 98.3% +/- 1.2% and 81.2% +/- 3.9%, respectively. Forty-nine (38.8%) patients died during the follow-up period. The 6-week and 1-year actuarial probabilities of survival were 98.4 +/- 1.1% and 65.6 +/- 4.4%, respectively. Two (1.6%) patients had major procedure-related complications, including acute liver failure (n = 1) and intra-abdominal bleeding (n = 1). Thirty-three (26.2%) patients had at least 1 episode of overt hepatic encephalopathy during the follow-up period. Shunt dysfunction occurred in 15 (11.9%) patients after a median follow-up time of 11.4 months (range, 1.4-41.3 months). Lung metastasis occurred in 3 (2.4%) patients, 3.9-32.9 months after TIPS creation. Conclusions: TIPS creation may be effective and safe for the prevention of gastric variceal rebleeding in patients with HCC.