Safety and efficacy of TIPS combined with iodine-125 seed strands in the treatment of patients with hepatocellular carcinoma combined with portal vein tumor thrombosis
10.3760/cma.j.cn501113-20210820-00415
- VernacularTitle:经颈静脉肝内门体分流术联合 125I粒子链治疗合并门静脉癌栓肝癌患者的安全性及疗效
- Author:
Xiadi WENG
1
;
Ling LI
;
Xinhui HUANG
;
Xia GUO
;
Xiaojuan LEI
;
Yubing JIAO
;
Feng LIN
;
Qiao KE
;
Wuhua GUO
Author Information
1. 福建医科大学孟超肝胆医院介入科，福州350025
- Keywords:
Hepatocellular carcinoma;
Portal vein tumor thrombus;
Transjugular intrahepatic portosystemic shunt;
Iodine-125 seed;
Complication
- From:
Chinese Journal of Hepatology
2022;30(6):618-623
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the safety and efficacy of transjugular intrahepatic portosystemic shunt (TIPS) combined with iodine-125 ( 125Ⅰ) seed strands implantation in patients with hepatocellular carcinoma combined with portal vein tumor thrombosis. Methods:25 cases with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ requiring TIPS were simultaneously implanted with 125Ⅰseed strand. Tumor thrombus was controlled with 125I seed implantation brachytherapy to keep the TIPS pathway unobstructed, reduce the portal vein pressure, and observe the changes in the cause of death of the patients. During the same period, 30 cases without TIPS and seed strand implantation were used as controls. Data between groups were compared using t-test, Chi-Squared test or Fisher's exact test. Results:TIPS combined with 125Ⅰ seed strand implantation was safe in patients with diffuse hepatocellular carcinoma combined with type III/IV portal vein tumor thrombus, and 92.0% (23/25) of the patients maintained unobstructed TIPS pathway. Compared with the control group, patients in the treatment group died of fewer lead-related complications, and most died from chronic liver failure (84.0% vs. 56.7%, χ2 = 4.771, P=0.029). The incidence of upper gastrointestinal bleeding was significantly decreased (12.0% vs. 46.7%, χ2 =7.674, P=0.006) and ascites severity was significantly improved (mild 40.0% vs. 16.7%, moderate 52.0% vs. 20.0%, severe 8.0% vs. 46.7%, χ2 =13.246 , P=0.001). Conclusions:TIPS combined with 125Ⅰ seed strand implantation is safe and feasible in patients with diffuse intrahepatic tumor combined with tumor thrombus type Ⅲ/Ⅳ. Moreover, it can effectively keep the shunt patency and reduce portal vein pressure, thereby reducing the incidence of upper gastrointestinal bleeding and improving the degree of ascites. TIPS combined with 125Ⅰ seed strand implantation may be used as a standard treatment modality for patients requiring TIPS therapy combined with tumor thrombus type Ⅲ/Ⅳ.
