激光消融治疗肝癌门静脉癌栓93例报告  

Percutaneous laser ablation in the treatment of portal vein tumor thrombus in 93 hepatocellular carcinoma patients

作　　者：陆正华[1] 沈锋[1] 袁国新[1] 施乐华[1] 宗明[1] 杨家和[1] 郭佳[1] 吴孟超[1] 

机构地区：[1]第二军医大学东方肝胆外科医院,上海200438

出　　处：《中华肿瘤杂志》2007年第6期449-452,共4页Chinese Journal of Oncology

基　　金：上海市科学技术委员会资助项目(064119601)

摘　　要：目的探讨经皮、经肝门静脉穿刺激光消融治疗肝癌门静脉癌栓的疗效及其临床意义。方法对肝癌门静脉癌栓患者行经皮经肝门静脉穿刺激光消融治疗,观察患者术后的生存率、癌栓的变化、癌栓支门静脉血流的变化及临床症状、肝功能和腹水等的变化情况。结果93例门静脉癌栓患者行激光消融治疗后6个月、1年和2年的生存率分别为82.8%、53.0%和34.1%。其中11例癌栓部分阻塞者的癌栓截面积在6个月时明显缩小;82例术前癌栓支门静脉完全无血流信号的患者,行激光治疗后第1天均观察剑彩色血流信号。1个月后67例、3个月后57例、6个月后40例、1年后27例、2年后4例患者癌栓部位门静脉支再次观察到彩色血流信号。38例激光消融(LA)治疗后生存1年的患者中,14例癌栓萎缩,直至消失;14例癌栓萎缩,门静脉呈蜂窝状改变;10例癌栓不缩小甚至继续生长,门静脉增宽。接受治疗后,患者临床症状、肝功能和腹水均得到不同程度的改善。结论激光消融治疗肝细胞癌门静脉癌栓,是一种疗效可靠、技术安全的新方法。Objective To evaluate the efficacy of percutaneous laser ablation （LA） in the treatment for portal vein tumor thrombus （PVTT） of hepatocellular carcinoma （ HCC ）. Methods The PVTT of HCC patients were treated through percutaneous transhepatic laser ablation （PTLA）. The survival rate, thrombus size, blood flow of embolized portal vein by thrombus, liver function, ascites and clinical presentation were observed. Results The 6-month, 1-year and 2-year survival rate of these 93 patients were 82.8%, 53.0% and 34.1%, respectively. In 11 patients with partially occluded portal vein by PV3W, the cut-surface of the PVTT diminished significantly 6 months after LA. The color blood stream signal was seen again one day after LA in all of the other 82 patients with totally occluded portal vein by thrombus, and it could still be seen in 67 of those one month later, 57 （of71） 3 months later, 40 （of57） 6 months later, 27 （ of 32 ） 1 year and 4 （ of 6） 2 years later after LA. In the 38 patients who survived over 1 year, PVTT was gradually atrophied and disappeared eventually in 14, PVTT was atrophied and the portal vein changed into honeycomb-like appearance in 14. In the remaining 10 patients, PVTT continued to grow and made the portal vein enlarged. It was also observed that liver function,clinical symptom and ascites were improved in various degree after LA. Conclusion Percutaneous laser ablation might be an effective and safe treatment method for controlling portal vein tumor thrombus of hepatocellular carcinoma.

关 键 词：门静脉癌栓 肝细胞癌 经皮激光消融治疗 

分 类 号：R735.7[医药卫生—肿瘤]