门静脉支架及经动脉药物治疗栓塞联合或未联合血管内植入碘-125粒子条治疗肝癌合并门静脉主干癌栓的比较  

Comparative study of portal vein stent and TACE combined therapy with or without endovascular implantation of iodine-125 seeds strand for treating patients with hepatocellular carcinoma and main portal vein tumor thrombus

作　　者：吴林霖[1] 罗剑钧[1] 颜志平[1] 王建华[1] 王小林[1] 张学彬[1] 方主亭[1] 张雯[1] 

机构地区：[1]复旦大学中山医院介入科,上海200032

出　　处：《中华肝脏病杂志》2012年第12期915-919,共5页Chinese Journal of Hepatology

摘　　要：目的比较门静脉支架及经动脉药物治疗栓塞（TACE）联合或未联合血管内植入碘-125（^125I）粒子条治疗原发性肝癌伴门静脉主干癌栓的疗效。方法对106例（男94例，女12例，平均年龄53．23岁）在我院接受TACE治疗的原发陛肝癌合并门静脉主干癌栓患者的资料进行回顾性分析，其中56例（A组）在门静脉内植入支架及^125I粒子条，余50例（B组）仅在门静脉内植入支架。分别对两组患者的生存期、支架通畅率及相关不良事件进行分析。对治疗前后各测量值的改变采用配对样本t检验，计数资料采用x^2检验，用Kaplan-Meier法分析生存时间及支架通畅期。结果门静脉内植入支架及^125I粒子条的技术成功率为100％，无严重相关不良事件发生。两组患者中位生存期分别为335d（A组）及146d（B组），P=0．001（P〈0．05）及HR=2．244；两组患者支架的中位通畅期分别为400d（A组）及190d（B组），P=0．005（P〈0．05）及HR=2．479。结论门静脉支架及TACE联合血管内植入^125I粒子条能显著延长原发陛肝癌伴门静脉主干癌栓患者的生存期。Objective To compare the efficacies of portal vein stenting and transcatheter arterial chemoembolization （TACE） combined therapy performed with or without endovascular implantation of iodine-125 （125I） seeds strand in patients with hepatocellular carcinoma （HCC） and main portal vein tumor thrombus （MPVTT）. Methods One-hundred-and-six patients with HCC complicated by MPVTT who were treated with portal vein stents and TACE, either with （Group A, n = 56） or without （Group B, n = 50） endovascular implantation of J251 seeds strand, between July 2005 and April 201 I, were retrospectively analyzed. Overall survival, stent patency, and procedure-related adverse events were compared between the two groups. Results The technical success rate was 100% for placement of 125I seeds strands and stents in the obstructed main portal vein. No serious procedure-related adverse events were recorded. Group A had significantly higher median survival （335 days vs. group B： 146 days; P = 0.001, hazard ratio （HR） = 2.244）. Additionally, group A had significantly higher median stent patency （400 days vs. group B： 190 days; P = 0.005, HR = 2.479）. Conclusion The combination therapeutic strategy of portal vein stenting and TACE with endovascular implantation of 125I seeds strands improves the survival of HCC patients with MPVTT complication.

关 键 词：癌 肝细胞 门静脉 癌栓 支架 碘-125粒子条 经动脉药物 治疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤]