高强度聚焦超声与超声引导穿刺无水酒精注射治疗门静脉癌栓的比较  

Comparison of High-intensity Focused Ultrasound with Percutaneous Anhydrous Alcohol Locally Injection Guided by Ultrasound on Curing Portal Vein Tumor Thrombosis

作　　者：裴峰[1] 徐周敏[2] 李娜[1] 黄德美 秦士新[3] 刘玉祥[4] 

机构地区：[1]中国人民武装警察部队上海市总队医院超声科,上海201103 [2]中国人民武装警察部队上海市总队医院肿瘤科,上海201103 [3]中国人民武装警察部队上海市总队医院医务处,上海201103 [4]中国人民武装警察部队上海市总队医院普通外科,上海201103

出　　处：《肿瘤防治研究》2011年第4期447-451,共5页Cancer Research on Prevention and Treatment

摘　　要：目的对比观察高强度聚焦超声(HIFU)与超声引导穿刺无水酒精注射治疗门静脉癌栓(PVTT)的疗效和不良反应。方法回顾性分析我院原发性肝癌(PLC)合并PVTT患者86例的治疗情况,在肝癌肿块行TACE治疗的基础上,对于癌栓的治疗,52例(A组)为HIFU治疗,34例(B组)为超声引导穿刺无水酒精注射治疗,对比评价两组PVTT治疗的近期有效率(CR+PR)%、临床受益率(CBR)、生存期及不良反应。结果 A组近期有效率40.38%,B组41.18%,两组比较差异无统计学意义(P=0.1493)。A组CBR为48.08%,B组为23.53%,两组比较差异有统计学意义(P=0.0102)。两组的生存期和中位生存期分别为3.6～23.5月和12.3月、4.2～21.3月和11.5月,两组比较差异无统计学意义(P=0.1504)。主要不良反应为:A、B两组少数病例有上消化道出血,B组多数病例有肝区胀痛、发热、肝包膜下出血,B组的不良反应发生率明显高于A组,两组差异有统计学意义(P=0.0051)。结论 HIFU与无水酒精注射治疗的近期疗效与远期疗效相似,在改善患者临床状态等方面优于无水酒精注射治疗,治疗的不良反应明显低于无水酒精注射,HIFU比无水酒精注射有更高的安全性,应用范围广,能适合肝功能异常、伴有腹水、病情较重不能耐受其他方法治疗的肝癌伴门静脉癌栓患者。Objective To compare the efficacy and side effects of high-intensity focused ultrasound（HIFU） with anhydrous alcohol injection guided by ultrasound on patients with portal vein tumor thrombosis（PVTT）.Methods 86 patients with primary liver cancer（PLC） combined with PVTT in our hospital were retrospectively analyzed.Liver lesions were basically treated with transcatheter arterial chemoembolization（TACE）,and HIFU or percutaneous anhydrous alcohol injection were sued as complimentary treatment to 52 cases（group A） and 34 cases（group B）,respectively.Response rate（RR）,clinical beneficial response（CBR）,overall survival（OS） and side effects were evaluated between two groups.Results RR in group A and B were 40.38% vs.41.18%（P=0.1493）,CBR were 48.08% vs.23.53%（P=0.0102）,median OS were 12.3 months（range：3.6~23.5） vs.11.5 months（range： 4.2~21.3）（P=0.1504）.Main side effects occurred in group A was upper gastrointestinal（GI） hemorrhage and liver area pain,while fever and hemorrhage under liver capsule occurred in group B.The occurance rates of side effects in group B were much higher than those in group A（P=0.0051）.Conclusion HIFU and percutaneous anhydrous alcohol injection guided by ultrasound are both safe and effective approaches for therapy of PVTT.The short-term and long-term response was similar in two groups,while HIFU was superior to anhydrous alcohol injection on CBR and side effects.HIFU maybe a good choice patients with disordered liver function,ascites and intolerable to other methods.

关 键 词：门静脉 癌栓 高强度聚焦超声 超声引导介入治疗 无水酒精 

分 类 号：R735.7[医药卫生—肿瘤]