门脉支架及TACE联合或未联合血管内植入碘-125(^(125)I)粒子条治疗肝癌合并门脉主干癌栓(MPVTT)的随机对照研究  

Randomized comparative study of HCC with MPVTT treated by portal vein stent and TACE combined with or without endovascular implantation of Iodine-125 (^(125)I ) seeds strand

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

机构地区：[1]复旦大学附属中山医院介入科,上海200032

出　　处：《复旦学报（医学版）》2013年第3期354-359,共6页Fudan University Journal of Medical Sciences

摘　　要：目的随机分组对照探讨经动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)及门脉内植入支架联合或未联合血管内植入碘-125(125Ⅰ)粒子条治疗原发性肝癌(hepatocellular carcinoma,HCC)伴门脉主干癌栓(main portal vein tumor thrombus,MPVTT)的临床疗效。方法选择2009年2月至2011年4月于我院接受肝癌TACE治疗的60例HCC合并MPVTT患者(男52例,女8例,平均年龄53岁)进行随机分组。A组在门脉内植入支架及125Ⅰ粒子条,B组仅在门脉内植入支架,每组30例。分别对两组患者进行生存期、支架通畅率及相关不良事件的分析。结果门脉内植入支架及125Ⅰ粒子条介入技术成功率为100%,无严重手术并发症及相关不良事件发生。A组和B组患者的中位生存期分别为335天及142天(P=0.002,HR=2.683)。A组和B组患者支架的中位通畅期分别为340天及190天(P=0.038,HR=2.252)。结论门脉支架及TACE联合血管内植入125I粒子条能明显延长HCC伴MPVTT患者的支架通畅期、生存期,提高患者生存质量,是临床治疗HCC合并MPVTT的重大突破。Objective To randomized block design and compare the efficacy of hepatocellular carcinoma （HCC） with main portal vein tumor thrombus （MPVTT） treated by portal vein stent and transcatneter arterial chemoembolization （TACE） combined with or without endovascular implantation of Iodine-125 （^125I） seeds strand. Methods Sixty patients with HCC complicated by MPVTT who received portal vein stent and TACE combined with （group A, n = 30） or without （group B, n = 30） endovascular implantation of ^125I seeds strand in our hospital during Feb. 2009 and Apr. 2011 were analyzed retrospectively. Overall survival, stent patency and procedure-related adverse event were compared between the two groups. Results Technical success rate was 100 % for placement of ^125I seeds strand and stent in the obstructed main portal vein. No serious procedure-related adverse events occurred. Median survival time of group A and B were 335 days and 142 days, respectively （P = 0. 002, HR = 2. 683） ; Median stent patency period of group A and B were 340 days and 190 days, respectively （P = 0. 038, HR = 2. 252）. Conclusions Portal vein stent and TACE combined with endovascular implantation of ^125I seeds strand could improve the survival time, stent patency period of patients with HCC complicated by MPVTT and improve their quality of life effectively. It is a new approach to treat HCC with MPVTT.

关 键 词：原发性肝癌(HCC) 门脉主干癌栓(MPVTT) 经动脉化疗栓塞(TACE) 碘-125粒子条 门脉支架 

分 类 号：R735.7[医药卫生—肿瘤] R730.5[医药卫生—临床医学]