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Volume 40 Issue 10
Oct.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(10): 2027-2033

Efficacy of transjugular intrahepatic portosystemic shunt in treatment of hepatocellular carcinoma comorbid with esophagogastric variceal bleeding

DOI: 10.12449/JCH241016
  • 1.

    Hepatology Unit，Nanfang Hospital，Southern Medical University，Guangzhou 510515，China

  • 2.

    Department of Hepatology，Zengcheng Branch of Nanfang Hospital，Southern Medical University，Guangzhou 511300，China

  • 3.

    Hepatology Institute of Guangdong Province，Guangzhou 510515，China

Research funding:

National Natural Science Foundation of China (82300698);

National Natural Science Foundation of China (82370614)

More Information
  • Corresponding author: CHEN Jinjun， chjj@smu.edu.cn （ORCID： 0000-0003-4275-9149）; LUO Xiaoqin， lingdu618@126.com （ORCID： 0009-0002-3907-1087）
  • Received Date: 2024-01-12
  • Accepted Date: 2024-03-04
  • Published Date: 2024-10-25
    Abstract
  •   Objective  To investigate the efficacy of transjugular intrahepatic portosystemic shunt （TIPS） in preventing rebleeding in patients with hepatocellular carcinoma （HCC） comorbid with esophagogastric variceal bleeding and the influencing factors for prognosis.  Methods  A retrospective analysis was performed for the clinical data of 35 HCC patients comorbid with esophagogastric variceal bleeding who were admitted to Zengcheng Branch of Nanfang Hospital， Southern Medical University， and were treated with TIPS from July 2019 to April 2023. The Kaplan-Meier curve was used to assess rebleeding rate and survival rate after TIPS， and the Cox regression model was used to investigate the influencing factors for postoperative rebleeding and survival.  Results  The TIPS procedure was technically successful in all patients， with a median follow-up time of 16.4 months. During follow-up， 11 patients （31.4%） experienced esophagogastric variceal rebleeding， with the 1-month， 3-month， and 1-year rebleeding rates of 5.7%， 17.1%， and 28.6%， respectively. White blood cell count （WBC） （risk ratio ［HR］=1.31， 95% confidence interval ［CI］： 1.04 ‍—‍ 1.64， P=0.021）， number of tumors ≥3 （HR=35.68， 95%CI： 1.74 ‍—‍ 733.79， P=0.021）， and portal pressure gradient before TIPS （HR=0.85， 95%CI： 0.73 ‍—‍ 0.99， P=0.032） were independent predictive factors for rebleeding after TIPS. Shunt dysfunction was observed in 5 patients after surgery. A total of 19 patients died during follow-up， with a median survival time of 9.6 months. Portal vein tumor thrombosis （PVTT） （HR=7.04， 95%CI： 1.31 ‍—‍ 37.78， P=0.023）， total bilirubin （TBil） （HR=1.02， 95%CI： 1.00 ‍—‍ 1.03， P=0.042）， and serum albumin （HR=0.82， 95%CI： 0.72 ‍—‍ 0.94， P=0.004） were independent predictive factors for survival after TIPS.  Conclusion  TIPS procedure can be used as a therapeutic option to prevent esophagogastric variceal rebleeding in patients with HCC. Patients with a relatively high level of WBC or TBil or those with PVTT tend to have a poorer prognosis， and the application of TIPS treatment in such patients should be determined with caution.

     

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