门静脉支架置入联合动脉化疗栓塞和序贯门静脉放疗治疗肝癌合并门静脉主干癌栓  

Hepatocellular carcinoma complicated by main portal vein tumor thrombus： treated by portal vein stenting, tansarterial chemoembolization and 3-dimensional conformal radiotherapy

作　　者：张学彬[1] 王建华[1] 颜志平[1] 钱晟[1] 杜世锁[2] 曾昭冲[2] 

机构地区：[1]复旦大学附属中山医院放射科,上海200032 [2]复旦大学附属中山医院放疗科,上海200032

出　　处：《中华放射学杂志》2008年第12期1311-1315,共5页Chinese Journal of Radiology

摘　　要：目的回顾性分析肝细胞肝癌伴门静脉主干癌栓（MPVTT）患者经门静脉支架置入及经导管化疗栓塞治疗后序贯门静脉适形放疗的效果。方法45例肝癌合并MPVTT的患者行经皮门静脉支架置入，支架置入后即刻行经导管动脉内化疗栓塞。其中16例于2—3周后行门静脉适形放疗（A组），29例未行放射治疗（B组）。采用Kaplan—Meier生存分析、log-rank检验评价两组间支架通畅率、累积生存率的差异；Fisher精确概率法对比分析两组间肿瘤及癌栓缓解率的差别。结果本组支架放置过程中及置入后24h内无患者死亡，无大出血及急性肝功能衰竭等严重并发症。支架置入后2周内所有支架通畅，术后60、180、360d支架累积通畅率：A组分别为100．0％．62．2％、34．6％，B组分别为58．6％、21．7％、10．8％；累积生存率：A组分别为93．8％、81．3％、32．5％，B组分别为86．2％、13．8％、6．9％，两组相比差异均有统计学意义（x^2值分别为9．672、14．596，P值均〈0．01）。支架平均通畅时间A组为（475±137）d，B组为（200±61）d，两组相比差异有统计学意义（x^2=9．672，P〈0．01）。结论经导管化疗栓塞联合门静脉支架置入后序贯门静脉适形放疗可提高肝细胞肝癌伴MPVTT患者支架通畅率和生存期。Objective To retrospectively analyze the role of 3-dimensional conformal radiotherapy （3-DCRT） after percutaneous transhepatic portal vein stenting and transcatheter arterial chemoembolization （PTPVS-TACE） in the treatment of patients with hepatoeellular carcinoma （HCC） complicated by main portal vein tumor thrombus （MPVTr）. Methods Between July 2002 and July 2007, 45 patients with HCC complicated by MPVTT were treated by PTPVS-TACE. Among them, 3-DCRT were undertaken for MPVTT in 16 patients （group A）, the other 29 patients were not treated with 3-DCRT （group B）. The clinical effects, complication, stent patency rates, cumulative survival rates were evaluated among groups. The Kaplan-Meier method and log-rank test were used for survival analysis. Results No patient died during stent placement or within the preceding first 24 hours. No severe procedure-related complications were observed. The 60-, 180-, 360-day cumulative stent patency rates were 100. 0%, 62. 2% and 34. 6% in group A, and 58.6%, 21.7% and 10. 8% in group B, respectively, showing significant difference between the two groups （x^2 =9. 672,P 〈 0. 01 ）. The mean patency time was（475 ± 137）and （200 ± 61 ） days, respectively. The 60-, 180-, and 360-day cumulative survival rates were 93.8% , 81.3% and 32. 5% for group A, 86. 2%, 13.8% and 6. 9% for group B, respectively. There were significant statistical differences between the two groups （ x^2 = 9. 672,14. 596, P 〈 0. 01 ）. Conclusion Treatment with PTPVS- TACE-3-DCRT is a more effective modality than PTPVS-TACE for HCC complicated by MPVTT.

关 键 词：癌 肝细胞 门静脉 化学栓塞 治疗性 支架 放射疗法 适形 

分 类 号：R686[医药卫生—骨科学]