无水乙醇在原发性肝癌合并门静脉癌栓经导管动脉栓塞术中的应用价值  

Appilcation value and clinical curative effectiveness of ethanol in transcatheter arterial embolization for hepatocllular carcinoma(HCC) with portal vein tumor thrombus

作　　者：罗小平[1] 淦伟[1] 何锦江[1] 何明菊[1] 

机构地区：[1]重庆医科大学附属第二医院介入治疗中心,重庆400010

出　　处：《重庆医科大学学报》2008年第7期831-834,838,共5页Journal of Chongqing Medical University

摘　　要：目的:回顾性研究超选择性门静脉癌栓(Protal vein tumor thrombus,PVTT)滋养动脉内注射无水乙醇及主癌灶超选择性完全性供瘤动脉栓塞的疗效,评价无水乙醇在局部治疗中的作用,以期提高该类患者的临床疗效。方法:对我院2001￣2004年发现的86例原发性肝癌合并门静脉癌栓的病例实施癌栓滋养动脉超选择性插管并以无水乙醇或无水乙醇+明胶海绵或无水乙醇+碘油实施栓塞,同时对主癌灶滋养动脉实施超选择性TACE或无水乙醇+碘油栓塞治疗。随访时间为2001￣2007年。结果:86例均成功实施癌栓及主癌灶滋养动脉超选择性栓塞;术后腹水消失或明显减少66.3%(57/86),腹水部分减少23.2%(20/86),腹水无明显减少10.5%(9/86);术后7￣10d,肝功能明显好转及好转71%(61/86)、肝功能变化不明显11.6%(10/86)、肝功能减低6%(5/86)、无显著肝功能减低或肝衰竭发生;术后3、6、12、24、36月生存率分别为97.7%(84/86)、95.3%(82/86)、72.1%(62/86)、47.7%(41/86)、16.3%(14/86)。结论:无水乙醇超选择性PVTT滋养动脉栓塞治疗可安全、有效阻断PVTT的血液供应而使癌栓坏死,同期进行主癌灶超选择性TAE或TACE治疗,可以明显提高患者的生活质量、延长生存期。Objective：To retrospectively study the effect and curative effectiveness of ethanol in treating HCC with portal vein tumor thrombus （PVVT） through transcatheter fed arterial super selective infusion and super selective arterial embolization of main tumor,appraise the effect of ethanol in local treatment,in order to improve the clinical curative effects on the patients. Methods：The data of study from 86 cases of HCC with PVVT in our hospital between 2001-2004 year,to the fed artery of portal vein tumor thrombus super selective infusion ethanol or ethanol and gelfoam or ethanol and lipiodol,also through transcatheter super selective embolizing the fed arterys of main tumors including TACE or ethanol and lipiodol in 86 cases HCC. The course of observation was between 2001 and 2007year. Results：The super selective fed arterial embolization of PVVT and main tumors were successful in all cases;After treatment,ascites disappeared or obviously reduced in 66.3%（57/86） of cases,reduce in 23.2%（20/86）,did not reduce in 10.5%（9/86）;After 7-10d,hepatic function obviously improve or improve in 71%（61/86）,did not obviously change in 11.6%（10/86）,lowered in 6%（5/86）,with no obvious lowering of hepatic function or hepatic function failure.The survival rates at 3,6,12,24,36months were 97.7%（84/86）,95.5%（82/86）,72.7%（62/86）,47.7% （41/86） and 16.3%（14/86） respectively. Conclusion：The therapy of ethanol through catheter super selective PVVT fed arterial infusion is safe and effective,combined with super selective TAE or TACE to the fed artery of main tumor,could obviously improve the quality of life of the patients and could improve the survival rate.

关 键 词：无水乙醇 肝癌 门静脉 癌栓 栓塞 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]