Outcomes of transjugular intrahepatic portosystemic shunt combined with transcatheter arterial chemoembolization sequential thermal ablation in the treatment of portal hypertension with hepatocellular carcinoma

doi:10.3877/cma.j.issn.2095-5782.2021.03.003

Abstract

Abstract:

Objective

To evaluate the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with transcatheter arterial chemoembolization (TACE) sequential CT-guided thermal ablation (TA) in the treatment of portal hypertension complication (PHC) with hepatocellular carcinoma (HCC).

Methods

Clinical data of 22 patients with PHC and HCC treated with TIPS combined with TACE sequential TA were collected retrospectively. Paired t test was used to compare paired measurement data. The Kaplan-Meier method was employed to calculate the cumulative complications rate of no portal hypertension, cumulative shunt patency rate, progression-free survival (PFS) and overall survival (OS).

Results

TIPS was successful in 22 patients. All patients had no serious perioperative complications, and the perioperative mortality was 0. The 3 months and 6 months cumulative complications rates of no portal hypertension were 95.24% and 90.48%, respectively. The 12 and 24 months cumulative shunt patency rates were 83.57% and 54.70%, respectively. The 12, 24 and 60 months PFS after TACE sequential TA were 61.30%, 43.78% and 10.95%, respectively. The median PFS was 20.6 months. The 12, 24 and 60 months survival rate after TACE sequential TA were 95.24%, 87.91% and 79.12%, respectively. The median OS was 95.0 months.

Conclusions

TIPS combined with TACE sequential CT-guided TA were safe and effective in the treatment of PHC combined with HCC.

Key words: Portal hypertension, Hepatocellular carcinoma, Transjugular intrahepatic portosystemic shunt, Transcatheter arterial chemoembolization, Ablation

Jianjun Li, Tong Zhu, Xiaozhen Yang, Shoupeng Sheng, Yonghong Zhang, Jiasheng Zheng. Outcomes of transjugular intrahepatic portosystemic shunt combined with transcatheter arterial chemoembolization sequential thermal ablation in the treatment of portal hypertension with hepatocellular carcinoma[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(03): 252-257,265.

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References 22

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项目		例数（例）	比例（%）
年龄（岁）
中位数（范围）		59（40~72）
性别
	男	22	100.00
	女	0	0
Child-Pugh分级
	A	10	45.45
	B	11	50.00
	C	1	4.55
AFP（ng/mL）
	中位数（范围）	12.10（1.78~1 600.00）
肿瘤直径（cm）
	中位数（范围）	2.10（1.10~7.00）
肿瘤数目
	单个	16	72.73
	多个	6	27.27
门脉癌栓
	是	1	4.55
	否	21	95.45
肝外转移
	是	0	0
	否	22	100.00
BCLC分期
	0	6	27.27
	A	11	50.00
	B	4	18.18
	C	1	4.55
门静脉高压并发症
	食管胃静脉曲张破裂出血	12	54.55
	顽固性腹腔积液	1	4.55
	食管胃静脉曲张破裂出血合并腹腔积液	9	40.90
Viatorr专用支架
	是	13	59.09
	否	9	40.91

项目		例数（例）	比例（%）
年龄（岁）
中位数（范围）		59（40~72）
性别
	男	22	100.00
	女	0	0
Child-Pugh分级
	A	10	45.45
	B	11	50.00
	C	1	4.55
AFP（ng/mL）
	中位数（范围）	12.10（1.78~1 600.00）
肿瘤直径（cm）
	中位数（范围）	2.10（1.10~7.00）
肿瘤数目
	单个	16	72.73
	多个	6	27.27
门脉癌栓
	是	1	4.55
	否	21	95.45
肝外转移
	是	0	0
	否	22	100.00
BCLC分期
	0	6	27.27
	A	11	50.00
	B	4	18.18
	C	1	4.55
门静脉高压并发症
	食管胃静脉曲张破裂出血	12	54.55
	顽固性腹腔积液	1	4.55
	食管胃静脉曲张破裂出血合并腹腔积液	9	40.90
Viatorr专用支架
	是	13	59.09
	否	9	40.91

变量	± s	t值	P值
TIPS术前总胆红素（μmol/L）	23.88 ± 17.15	-3.76	< 0.01
TIPS术后总胆红素（μmol/L）	37.74 ± 22.78
TIPS术前白蛋白（g/L）	30.82 ± 4.82	-0.84	0.43
TIPS术后白蛋白（g/L）	32.37 ± 5.18
TIPS术前ALBI	-1.77 ± 0.54	-0.06	0.96
TIPS术后ALBI	-1.76 ± 0.38

变量	± s	t值	P值
TIPS术前总胆红素（μmol/L）	23.88 ± 17.15	-3.76	< 0.01
TIPS术后总胆红素（μmol/L）	37.74 ± 22.78
TIPS术前白蛋白（g/L）	30.82 ± 4.82	-0.84	0.43
TIPS术后白蛋白（g/L）	32.37 ± 5.18
TIPS术前ALBI	-1.77 ± 0.54	-0.06	0.96
TIPS术后ALBI	-1.76 ± 0.38

变量	± s	t值	P值
TACE序贯热消融术前总胆红素（μmol/L）	28.09 ± 11.28	-1.68	0.13
TACE序贯热消融术后总胆红素（μmol/L）	30.18 ± 16.00
TACE序贯热消融术前白蛋白（g/L）	35.77 ± 3.57	1.24	0.25
TACE序贯热消融术后白蛋白（g/L）	33.56 ± 3.87
TACE序贯热消融术前ALBI	-2.11 ± 0.36	-1.54	0.16
TACE序贯热消融术后ALBI	-1.83 ± 0.36

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