布加综合征合并肝细胞癌的介入治疗  

Interventional treatment of hepatocellular carcinoma complicated by Budd-Chiari syndrome

作　　者：张庆桥[1] 祖茂衡[1] 徐浩[1] 顾玉明[1] 魏宁[1] 许伟[1] 刘洪涛[1] 崔艳峰[1] 王文亮[1] 

机构地区：[1]徐州医学院附属医院介入放射科,221002

出　　处：《中华放射学杂志》2010年第8期852-855,共4页Chinese Journal of Radiology

基　　金：国家“十一五”科技支撑计划基金资助项目（2006038073024）

摘　　要：目的探讨布加综合征合并肝细胞癌介入治疗的效果。方法回顾性分析17例布加综合征合并肝细胞癌患者的临床资料。布加综合征经彩色多普勒超声及血管造影确诊；肝细胞癌5例由肝穿刺细胞学检查确诊，12例由彩色多普勒超声、CT或MRI及甲胎蛋白（AFP）进行综合诊断。所有患者均施行下腔静脉成形术及动脉化疗栓塞术（TACE）。术后随访采用肝脏超声、CT及实验室检查，观察肿瘤大小、肝功能、AFP及下腔静脉通畅情况。采用t检验比较介入治疗前后压力变化。结果17例患者共进行了39次介入治疗，均成功，无并发症。下腔静脉成形术后：患者随访2～90个月，1例下腔静脉再闭塞，经第2次血管成形术开通。TACE术后：2个月时随访，所有患者均生存；15例随访6个月，13例生存；12例随访12个月，10例生存；8例随访24个月，5例生存。介入治疗后，下腔静脉-右心房压力差由术学的（20．5±2．1）cm H2O（1cmH2O=0．098kPa）降至（3．6±1．0）cm H2O，差异有统计学意义（t=30．32，P〈0．05）。结论布加综合征合并肝细胞癌的介入治疗可取得较好临床效果；Objective To evaluate the efficacy of interventional therapy for hepatocellular carcinoma complicated by Budd-Chiari syndrome. Methods Clinical data and imaging studies of 17 patients with hepatocellular carcinoma complicated by Budd-Chiari syndrome were retrospectively analyzed. Budd-Chiari syndrome was diagnosed by color Doppler ultrasound and confirmed by cavography in 17 patients. Hepatocellular carcinoma was diagnosed by fine-needle aspiration cytology in 5 patients,and by color Doppler ultrasound, computed tomography and /or MRI, and elevated level of alpha-fetoprotein in 12 patients. Both percutaneous transluminal angioplasty for treatment of obstruction of the inferior vena eava and transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma were performed in all patients. During follow-up, the tumor size, liver function, serum alpha-fetoprotein level and the reeanalized inferior vena cava were evaluated by liver ultrasound, CT and laboratory examination, t test was used to compare the pressure. Results Thirty-nlne interventional procedures were performed in 17 patients and all operations were successful without complications. Over the follow-up period of 2 to 90 months after percutaneous transluminal angioplasty in 17 patients, re-occlusion of inferior vena cava occurred in only one patient, which was redilated successfully. Following TACE, all 17 patients survived at two months follow- up, 13 patients survived at 6 months follow-up, 10 patients survived at 1 year follow-up, 5 patients survived at 2 years follow-up. The pressure of vena cava was （20. 5±2. 1 ） cm H20 （ 1 cm H2O =0. 098 kPa） before the interventional theraphy,while it was （3.6 ± 1.0） cm H2O after it （t = 30. 32, P 〈 0. 05 ）. Conclusion Interventional therapy can be effectively performed for treatment of hepatocellular carcinoma complicated by Budd-Chiari syndrome.

关 键 词：布加综合征 癌 肝细胞 血管成形术 栓塞 治疗性 

分 类 号：R735.7[医药卫生—肿瘤]