肝癌相关性门脉高压症的选择性介入治疗  

Selective Interventional Therapy for Liver Cancer Related Portal Hypertension

作　　者：朱军[1] 曹跃勇[1] 黄勇[1] 代勇[1] 刘智桃 杜旭洋 段宗强 

机构地区：[1]宜宾市第二人民医院,四川宜宾644000

出　　处：《华西医学》2013年第1期44-47,共4页West China Medical Journal

摘　　要：目的评价选择性介入治疗在原发性肝癌(HCC)门脉高压症中的应用价值。方法 2008年11月-2011年3月,收治65例临床明确诊断的HCC伴门脉高压症患者,选择性使用肝动脉化学疗法(化疗)栓塞术、脾栓塞术、门静脉化疗栓塞术、门静脉支架、胃冠状静脉栓塞术等介入术式,术后通过观察临床指标、定期复查影像检查等了解病变转归,随访生存期并评价疗效。结果 65例HCC患者均合并不同程度门静脉高压,其中门静脉癌栓46例中有37例显示肝动脉-门静脉分流,通过肝动脉及门静脉化疗栓塞术进行主瘤体及癌栓治疗。11例行门静脉支架置入术,支架置入后门静脉压较术前明显下降(P<0.01),支架中位通畅时间为5.8个月。39例行胃冠状静脉和(或)胃短静脉栓塞术,术后有4例再次发生门脉高压性出血,再出血率10.26%。18例行脾动脉栓塞术,术后3个月血小板较术前显著升高(P<0.01)。随访术后3、6、12及24个月的生存率分别为90.77%、69.23%、35.38%及13.85%。结论选择性联合使用各种介入术式是治疗HCC及其相关性门脉高压症的一种有效方法,可有效预防高危风险,延长患者生存期。Objective To explore the clinical value of selective interventional treatment for primary hepatocellular carcinoma（HCC） portal hypertension.Methods For 65 patients with HCC and portal hypertension treated between November 2008 and March 2011,we selectively used hepatic arterial chemoembolization,splenic embolization,portal vein chemoembolization,portal vein stents and gastric coronary vein embolization for the treatment.After surgery,we evaluated the treatment by observing clinical indexes and periodic review of imaging results.Clinical outcome was assessed and survival time was investigated during the follow-up.Results All 65 HCC patients had various degrees of portal hypertension,including portal vein tumor thrombi in 46 patients with 37 showing artery-portal vein bypass,and hepatic artery and portal vein chemoembolization was adopted in treating the tumors and the tumor thrombi.Eleven patients underwent portal vein stent placement,after which portal vein pressure declined significantly（P0.01）,and the median time of smooth flow was 5.8 months.Thirty-nine patients underwent stomach coronary arteriovenous and/or short gastric vein embolization,among which four had portal hypertension hemorrhage again with a re-bleeding rate of 10.26%.Eighteen patients underwent spleen artery embolization,and three months after the surgery,platelet level was improved significantly（P0.01）.During the follow-up,the survival rate at 3,6 months,1,and 2 years was respectively 90.77%,69.23%,35.38% and 13.85%.Conclusions Selective combination of various kinds of interventions is effective in treating liver cancer and its related portal hypertension,which can effectively prevent high risks and prolong patients＇ survival time.

关 键 词：原发性肝癌 门脉高压症 介入 肝动脉 门静脉 

分 类 号：R735.7[医药卫生—肿瘤]