Clinical Study On Transjugular Intrahepatic Portosystemic Shunt (TIPS) For The Treatment Of Portal Hypertension Of Patients With Hepatocellular Carcinoma

Backgroud and Aims Hepatocellular carcinoma (HCC) complicated by portal hypertension is very common. The causes of portal hypertension include cirrhosis, portal vein tumor thrombosis, arteriovenous shunt and so on. Thereinto, cirrhosis portal hypertension (CPH) is the most common. According to report, the patients with HCC complicated by cirrhosis account for about 70%. Portal hypertension is often complicated by venous hemorrhage, refractory ascites and hepatic failure. transjugular intrahepatic portosystemic shunt (TIPS) provides a considerable option for treatment on CPH and complications of it.This study is designed to evaluate the therapeutic efficacy and safety of TIPS for the treatment portal hypertension of patients with hepatocellular carcinoma. Methods 95 portal hypertension cases with hepatic carcinoma were included in our research. 63 cases of them received TIPS and the other 32 cases with support medical care. Related information after TIPS, such as treatment success, complications, causes of death, and so on, were assessed. The life time of the 95 patients after treatment was collected by follow-up visit. The Kaplan-Meier method was used to conduct the survival analyses.Results The success rate of TIPS was 97.8%. Mean portal vein pressure of the TIPS group was reduced with an average reduction of 13.6cmH2O. The ascites decreased and clinical symptoms relieved after TIPS. According to the follow-up, incidence rate of hepatic encephalopathy complicated with TIPS was 20.6% and rebleeding was 26.3%. 56 patients of TIPS group died until December 2008, and only 12 of them due to variceal bleeding complicated with portal hypertension. The median survival time of the TIPS group was about 3.67 months and significantly surpassed the control group, which median survival time was just 1 month. Moreover, the median survival time of patients in the group whose MELD scored not more than 13 was significantly longer than that in the other group (MELD>13). The same result was obtained among the subgroups classified from Child A to C.Conclusion TIPS is one of effective and safe therapeutic methods to control portal hypertension and its complications of patients with hepatocellular carcinoma. However, liver function is an important factor for case selection for TIPS.