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(Department of Gastroenterology， the Second Affiliated Hospital ofNanchang University， Nanchang 330006, China)



Application of transjugular intrahepatic portosystemic stent shunt combined with chemotherapy in treatment of hepatocellular carcinoma with portal vein tumor thrombosis

XIEZhengyuan,XIONGKai,GUOWuhua*

(DepartmentofGastroenterology，theSecondAffiliatedHospitalofNanchangUniversity，Nanchang330006,China)

Objective To explore the application value of transjugular intrahepatic portosystemic shunt (TIPS) combined with chemotherapy in treatment of hepatocellular carcinoma with portal vein tumor thrombus (PVTT). Methods According to therapeutic methods， totally 39 patients with hepatocellular carcinoma with PVTT, who were not appropriate surgical treatment or unwilling to surgical treatment were divided into two groups. There were 17 cases in treatment group and 22 cases in control group. For the patients of treatment group， the portal vein tumor thrombus were opened by TIPS. And the chemotherapy were performed with FOLFOX4 scheme. While for the patients of control group， only conservative treatments were performed. The incidence rate of complications， quality of life (QOL) scores and survival times between the two groups were compared. Results In treatment group， TIPS was performed successfully in 14 of 17 cases with the success rate of 82.35% (14/17). The incidence rates of combind upper gastrointestinal hemorrhage， intractable ascites of treatment group were lower than those of control group (bothP<0.05). The QOL scores of treatment group was higher than that of control group (P<0.05). The average survival times of patients were (114.50±47.18) days in treatment group and (88.10±36.81) days in control group. The difference of average survival times was statistically significant between the two groups (P<0.05). There was no statistical difference of the incidence rates of hepatic encephalopathy between the two groups (P=0.074). Conclusion TIPS combined with chemotherapy is a feasible and effective method for the treatment of hepatocellular carcinoma with PVTT.

Carcinoma, hepatocellular； Portal vein； Portasystemic shunt, transjugular intrahepatic； chemicals, therapeutic

门静脉癌栓(portal vein tumor thrombus, PVTT)的发生往往提示原发性肝癌已属晚期，此类患者大多失去外科手术机会，此时即使积极采取外科手术治疗，临床疗效也难以保证，患者总体生存期并无明显延长，且手术创伤大，可能使患者在有限的生存期内生活质量更为下降[1]。而单纯化疗也难以取得满意效果。近年来，我院采用经颈静脉肝内门体分流术(transjugular intrahepatic portosystemic shunt， TIPS)畅通门静脉及降低门静脉压后联合化疗对肝癌伴PVTT患者进行治疗，取得一定疗效，现报道如下。

1 资料与方法

1.1一般资料 2013年6月—2015年12月我院收治的原发性肝癌伴PVTT患者39例，男35例，女4例，年龄35～68岁，平均(52.6±11.4岁)。所有患者均符合2011版原发性肝癌诊疗规范[2]标准，并经CTA证实伴有确切的PVTT；均无外科手术治疗适应证和(或)无外科手术意愿。依据临床治疗方案分为两组，其中TIPS联合化疗组17例，接受TIPS治疗，术后接受化疗及常规内科药物治疗；对照组22例，仅接受内科药物护肝、输蛋白、利尿等对症处理。本研究经医院医学伦理委员会批准，接受治疗者均对治疗方案知情同意，并签署知情同意书。两组患者临床资料见表1。

1.2仪器与方法

1.2.1TIPS治疗 采用Philips FD20 Allura Xper FD20血管造影机作为影像引导设备。TIPS手术步骤包括：①行右颈内静脉穿刺后，引入导丝，将RUPS100置入肝中静脉或肝右静脉；②另行右股动脉穿刺，将导管置于肠系膜上动脉，行肠系膜上动脉造影，观察门静脉位置及与肝中静脉或肝右静脉空间方位；③调整RUPS100穿刺角度，穿刺门静脉，缓慢注入对比剂以显示门静脉走行，引入导丝，经门静脉主干超选择至肠系膜上静脉；……