The Application Of Transjugular Intrahepatic Portosystemic Shunt In Patients With Hepatocellular Carcinoma Accompanied By Portal Hypertension

Objective:Transjugular intrahepatic portosystemic shunt(TIPSS) was assessed by retrospectively analysis of the indications, efficacy, influencing factors and complications in patients with hepatocellular carcinoma accompanied by portal hypertension after applying TIPSS, which can evaluate and guide the the therapy in clinical application.Methods:Eleven patients with hepatocellular carcinoma accompanied by portal hypertension in Beijing Army General Hospital underwent TIPSS, from March 2000 to January 2010. We retrospectively analyzed the clinical information, including the variations of clinical symptoms, signs and laboratory examinations about one week before and after production of the application of TIPSS. Complications, survival and cause of death were followed up. Statistical analysis was done using SPSS 15.0 for Windows. The variations of laboratory examinations were assessed by paired t test or paired rank sum test, cumulative survival rate by life table method. The difference was deemed statistically significant at P<0.05.Results:Ten out of eleven patients chose to place a bare metal stent and another one chose stent-graft placement.The mean portal venous pressure significantly decreased from 27.23±9.45mmHg to 16.67±5.34mmHg. the clinical indexes including the levels of WBC, RBC, HB, PLT, TBIL, DBIL, ALT, ALB, ALP, GGT, NA, K and NH3 were not significantly deregulated in post-op group, compared with preoperative group, (P> 0.05). However, there were significant difference of the levels of SCr, CHE, PT and APTT in the two groups, (P<0.05). The postoperative complications were mainly included respiratory tract infection, subcutaneous hematoma, hepatic encephalopathy, stent restenosis and hepatic myelopathy. However, tumor metastasis was not found.And there was no upper gastrointestinal bleeding.what's more, ascites symptoms was relieved with varying degrees, untill January 1st,2009. Three patients were survival and 8 patients died.The survival time was from 18 to 743 days, with 233-day median survival time. The 30-,90-,180-and 360-day survival were 73%,64%,55%and 36%, respectively.Seven out of eight patient died of liver failure and one of pulmonary infection during the 8 cases of death.Conclusion:(1)TIPSS can effectively reduce portal pressure for patients suffered with hepatocellular carcinoma accompanied by portal hypertension who occurred with upper gastrointestinal bleeding or refractory ascites, TIPSS would also be used in patients, even if the patients accompanied by portal vein tumor thrombus.(2) The tumor site should be avoided when we established the shunt.And the possibility of tumor metastasis was little, even there were large tumors or multi-tumors.(3)To prevent contrast-induced nephropathy, it's better toselect low permeability non-ionic contrast agent without renal toxicity during operating TIPSS treatment.(4) Hepatic encephalopathy was the major postoperative complications of TIPSS,stent stenosis can be found in a few patients, and hepatic myelopathy can be occurred occasionally.(5) TACE or RFA can be used to relieve the liver lesions, when the tumor lesions developed in patients with stable liver function after TIPSS.