Clinical significance of transjugular intrahepatic portosystemic shunting for hepatocellular carcinoma complicated with portal hypertension.

Abstract

Background: Portal hypertension (PHT) and hepatocellular carcinoma (HCC) often appear concurrently in clinic, and PHT variceal bleeding arising due to systemic treatment of HCC remains a clinical issue that urgently requires a solution. This study aimed to examine the therapeutic effects and clinical significance of transjugular intrahepatic portosystemic shunting (TIPS) in patients with HCC complicated with PHT.

Methods: In this retrospective study, 21 patients with HCC complicated with PHT who were admitted to The Second Hospital of Nanjing between June 2018 and June 2023 were included. TIPS was performed, and liver and kidney function, blood routine, and biochemical indicators such as ammonia were examined preoperatively, at 1 week postoperatively, and at 1 month postoperatively. To determine the improvements in stent blood flow, ascites, and esophageal and gastric varices, ultrasound and/or enhanced computed tomography were performed. Treatment was evaluated based on the Modified Solid Tumor Efficacy Evaluation Criteria. Parameters such as portal vein pressure and portal blood flow before and after TIPS were analyzed using paired-sample t-tests.

Results: Postoperatively, the direct pressure of the portal vein of patients decreased significantly from 28.33±7.15 to 19.27±3.10 mmHg (P<0.05). The amount of ascites also significantly decreased, whereas esophageal and gastric varicose veins significantly improved. Meanwhile, no significant differences were observed in liver or kidney function indicators, including bilirubin, transaminase, and creatinine, from the preoperative to the postoperative period.

Conclusions: TIPS can effectively improve the various symptoms of PHT without increasing the incidence of liver function damage or other complications in patients with HCC complicated with PHT.