摘要
目的：探讨导致原发性肝癌伴门静脉高压症行经颈静脉肝内门体分流术（TIPSS）后发生肝衰竭的高危因素。材料和方法：回顾性收集2007年1月—2010年12月69例原发性肝癌伴门静脉高压症消化道出血和/或顽固性腹水患者行TIPSS治疗的临床资料和发生肝衰竭的情况，并应用统计学分析导致肝衰竭的高危因素。结果：69例TIPSS手术的成功率为100%，其中26例在TIPSS术后0.5~47月发生肝衰竭，11例经积极内科治疗后症状缓解，15例经治疗无效死亡。对发生肝衰竭的病例进行回顾性分析结果显示：CTP分级情况、肿瘤原始总直径、分流通道支架直径、是否合并有门静脉癌栓、TIPSS术前肝动脉化疗栓塞术（TACE/TAE）次数以及是否有外科手术史、TIPSS术后是否有再出血（包括新发生的出血）及肝性脑病均为原发性肝癌伴门静脉高压症TIPSS术后发生肝衰竭的高危因素。结论：TIPSS治疗原发性肝癌伴门静脉高压症是可行的，能有效降低门静脉压力，但有发生肝衰竭的风险，术前充分评估这些危险因素，筛选出适合TIPSS手术的患者，使其得到较高的获益。
Abstract
Objective: To analyze the risk factors which lead primary hepatocellular carcinoma with portal hypertension to hepatic failure after transjugular intrahepatic portosystemic stent shunt(TIPSS). Materials and Methods: From January 2007 to December 2010, a cohort of 69 hospitalized patients diagnosed as primary hepatocellular carcinoma with portal hypertension(refractory variceal hemorrhage and/or refractory ascites) treated with TIPSS were retrospectively studied, and data were abstracted including baseline characteristics of patients and the incidence of hepatic failure. We analyzed the risk factors which lead to hepatic failure by statistical methods. Results: Technical success rate was 100%. 26 cases got hepatic failure in 0.5~47 months after operation, of whom 11 cases got remission after aggressive medical therapy, 15 cases died. After retrospective analysis, we found Child-Turcotte-Pugh(CTP) grading, tumor diameter, the diameter of stent, whether combined with portal vein thrombosis, the time of transarterial chemoembolization(TACE)/hepatic artery embolization(TAE), either a history of surgical excision before TIPSS, or a history of recurrent bleeding and hepatic encephalopathy after TIPSS, were all risk factors. Conclusions: TIPSS can effectively relieve the symptoms of portal hypertension, but it has a risk of hepatic failure. Realized the factors that lead primary hepatocellular carcinoma with portal hypertension to hepatic failure after TIPSS, we can screen patients suitable for TIPSS to get better results.
关键词
肝肿瘤 /
高血压 /
门静脉 /
门体分流术 /
经颈静脉肝内
Key words
Liver neoplasms /
Hypertension /
portal /
Portasystemic shunt /
transjugular intrahepatic
赵孟菲;刘福全;岳振东;赵洪伟;王 磊;姚健楠;左 力;范振华.
原发性肝癌伴门静脉高压症TIPSS术后肝衰竭高危因素分析[J]. 中国临床医学影像杂志. 2013, 24(5): 328-333
ZHAO Meng-fei;LIU Fu-quan;YUE Zhen-dong;ZHAO Hong-wei;WANG Lei;YAO Jian-nan;ZUO Li;FAN Zhen-hua.
The risk factors of hepatic failure after transjugular intrahepatic portosystemic stent shunt forprimary hepatocellular carcinoma with portal hypertension[J]. Journal of China Clinic Medical Imaging. 2013, 24(5): 328-333
中图分类号：
Ｒ735.7
R657.34
Ｒ816.5
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