原发性肝癌致下腔静脉梗阻的介入性开通治疗  

The interventional therapy in the obstruction of inferior vena caused by primary hepatic cancer

作　　者：王朝加 刘清欣[2] 罗剑钧[2] 王成刚[2] 刘红南 

机构地区：[1]浙江省宁波市镇海龙赛医院放射科,浙江宁波315200 [2]复旦大学附属中山医院介入科,上海200032

出　　处：《医学影像学杂志》2009年第6期703-705,共3页Journal of Medical Imaging

摘　　要：目的:评价原发性肝癌引起的下腔静脉恶性梗阻Z形自膨式腔内支架介入治疗的疗效。方法:对46例原发性肝癌所致下腔静脉恶性梗阻患者采用Z形自膨式金属内支架治疗。术前对患者行CT或MRI检查了解下腔静脉梗阻情况及临床梗阻症状。放置支架前后分别行下腔静脉造影,测量梗阻段两端压力差。术后每1～2个月行下腔静脉造影或CT检查随访支架通常情况。结果:46例患者梗阻下腔静脉均开通成功,手术成功率100%(46/46)。2例患者因梗阻段超过10cm而置入2个支架,其余均置入1个支架。开通前后下腔静脉压由术前2.4±0.5kPa降至0.6±0.12kPa。经t检验,开通前后下腔静脉狭窄端压力变化具有非常显著差异(t=3.135,P<0.05)。术后1～5天患者症状明显改善,未见严重并发症发生。随访2～10个月,4例患者出现下腔静脉再狭窄,支架通畅率为91.3%(42/46)。结论:置入Z形自膨式金属支架,是对原发性肝癌引起的下腔静脉梗阻一种安全有效的姑息性治疗方法。Objective：To evaluate the effectiveness of endovascalar placement of metallic Z-type self-expandabie stents in treating the pantients with inferior vena cava （IVC） obstruction caused by primary hepatic cancer. Methods：46 patients with IVC obstrution caused by primary hepatic cancer were enrolled into this study. Before therapy, every patient underwent CT or MRI examination. All patients＇ clinical signs and syndrome due to malignant IVC sundrome were analysed. Venography was performed before and after metallic Z-type selfexpandable stent was implanted across the stenotie segment of IVC. Vein pressures were compared before and after stent placement. The patency of IVC was followed by CT or venography every two months. Results： Tectmical success was attained in 46 patients, technical success rate was 100%. 2 patients with IVC obstrution over 10 cm length were placed two stents. In other 45 patients, everyone was placed one stent. The pressure of stenotie segment of IVC dropped from 2.4 ± 0.5kPa before operation to 0.6 ± 0.12 kPa after operation. Through t examination, the difference of IV pressure before and after treament had statistic significance （ t = 3.135, P 〈 0.05）. After operations, the main syndrome and physical signs relieved in 1 - 5 days. There was no serious procedure-related complication. During 2 - 10 months follow-up, the patency of IVC stents reached 91.3%. Conclusion： Metallic Z-type self-expandable stents placement is a safe and effective palliantive treatment for patients with obsruction of IVC caused by primary hepatic cancer.

关 键 词：原发性肝癌 下腔静脉 狭窄或阻塞 支架 介入治疗 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]