Efficacy of transjugular intrahepatic portosystemic shunt with covered stents in the treatment of portal hypertension in 46 patients with primary hepatocellular carcinoma

Abstract

Objective To investigate the efficacy of transjugular intrahepatic portosystemic shunt (TIPS) with covered stent in the treatment of portal hypertension in patients with hepatocellular carcinoma. Methods The clinical data of 46 patients with primary hepatocellular carcinoma and portal hypertension who received TIPS with stent treatment were retrospectively analyzed. After treatment, liver function, shunt patency, re-bleeding rate, hepatic encephalopathy, ascites, gastric intestinal symptoms, lifetime and causes of death were analyzed. Compare t test was performed for measurement data comparison among groups. The survival curves were used to analyse the cumulative stent shunt patency rate, the incidence of hepatic encephalopathy and the survival rate. Results After the operation, portal vein pressure significantly decreased compared with that before operation [(16.2±4.6) mmHg vs (28.3±5.1) mmHg, 1 mmHg=0.133 kPa], and the difference was statistically significant (t=21.30, P 0.05]. Cumulative stent shunt patency at 3, 6, 12, 24, 36 month after operation was 100.0%, 95.6%, 93.5%, 91.3% and 91.3%, respectively. The cumulative incidence of hepatic encephalopathy was 6.5%, 8.7%, 13.0%, 17.4% and 26.1%, respectively; cumulative survival rate was 95.7%, 82.6%, 67.4%, 43.5% and 32.6%, respectively. In 10 cases of refractory ascites, ascites of all the patients reduced with different degree after operation and gastrointestinal uncomfortable symptoms were relieved. Conclusion In patients with primary hepatocellular carcinoma and portal hypertension, who have gastrointestinal bleeding or refractory ascites, treatment of TIPS with covered stents could effectively lower portal pressure, prevent re-bleeding and reduce the volume of ascites. Key words: Portosystemic shunt, transjugular intrahepatic; Primary hepatocellular carcinoma; Liver cirrhosis; Hypertension, portal