门静脉支架联合^125I粒子链植入序贯肝动脉灌注化学疗法栓塞术治疗肝癌伴门静脉癌栓  

Portal vein stenting combined 125I particle implanted followed by transarterial chemoembolization in thetreatment of hepatocellular carcinoma with portal vein tumor thrombus

作　　者：孙军辉[1] 周坦洋[1] 张岳林[1] 李琚[1] 聂春晖[1] 周官辉[1] 朱统寅[1] 陈黎明[1] 王伟林[1] 郑树森[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科肝胆胰介入中心,杭州310003

出　　处：《中华消化杂志》2014年第1期25-29,共5页Chinese Journal of Digestion

基　　金：基金项目：国家传染病重大专项（2012ZX10002-017）;国家自然科学基金（8137i658,30901446,811723i5）

摘　　要：目的探讨门静脉支架联合^125I粒子链植入序贯肝动脉灌注化学疗法栓塞术（TACE）治疗肝癌伴门静脉癌栓的临床价值。方法回顾性分析26例肝癌伴门静脉癌栓患者的临床资料。所有患者均先行经皮肝穿刺门静脉支架联合^125I粒子链植入术，然后再行TACE治疗。随访并计算累积生存率。结果26例患者中，男25例，女1例，中位年龄为49岁。肝内单发病灶10例，其中右肝癌8例，左肝癌2例，多发病灶16例。门静脉右支癌栓6例，门静脉左支癌栓3例，门静脉主干和右支癌栓13例，门静脉主干和左支癌栓4例。Child—PughA级20例，Child—PughB级6例。所有患者顺利完成门静脉支架联合^125I粒子链序贯TACE治疗，手术成功率为100％。共植入支架26枚、^125I粒子链28条（共520粒125I粒子），TACE治疗共55次。所有患者均未出现穿刺道出血、胆汁漏并发感染、肝脓肿、腹腔出血、肿瘤破裂出血及消化道出血等严重并发症。术后随访6～15个月。术后3、6、9、12及15个月的累积生存率为100．0％（26／26）、61．5％（16／26）、53．8％（14／26）、30．8％（8／26）、15．4％（4／26）；支架累积通畅率为96．2％（25／26）、76．9％（20／26）、57．7％（15／26）、23．1％（7／26）、7．7％（2／26）。16例死亡患者中，2例死于肺转移，5例死于消化道出血，6例死于肝功能衰竭，1例死于脑转移，1例死于椎体转移，1例肿瘤侵及心房导致心功能衰竭死亡。结论门静脉支架联合^125I粒子链植入联合TACE治疗肝癌伴门静脉癌栓患者，可获较长支架通畅时间和生存期。Objective To assess the clinical value of portal vein stenting （PVS） combined 125I particle implanted followed by transcatheter arterial chemoembolization （TACE） in the treatment of hepatocellular carcinoma （HCC） with main portal vein tumor thrombus （MPVTT）. Methods The clinical data of 26 patients with HCC accompanied with MPVTT were retrospectively analyzed. All the patients received PVS combined 125I particle implanted first and TACE treatment later. The patients were followed-up and the cumulative survival rate was calculated. Results There were 25 male, one female and the median age was 49 years. Sixteen cases had multiple lesions in the liver and 10 cases had single lesion. Among those, the lesion of eight cases was in right lobe and two in left lobe. A total of six patients with right portal vein tumor thrombus, three with left portal vein tumor thrombus, 13 with main and right portal vein tumor thrombus and four with main and left portal vein tumor thrombus. The liver function grading of 20 patients was Child-Pugh A and six was Child Pugh B. All the patients received PVScombined 12sI particle implanted followed by TACE treatment successfully, the success rate of operation was 100M. A total of 26 stents and 28 125I particle chains （520 125I particles） were implanted and 55 TACE were operated. In all the patients, no severe complications, such as puncture bleeding, bile leak complicated by infection, liver abscess, abdominal bleeding, tumor rupture bleeding and gastrointestinal bleeding occurred. After operation, patients were followed-up for 6 to 15 months. The survival rates at 3th, 6th, 9th, 12thand 15thmonth were 100.0% （26/26）,61.5% （16/26）,53.8% （14/26）,30.8% （8/26） and 15.4% （4/26）, respectively. The stent patency rates were 96.2% （25/26） ,76.9% （20/26）, 57.7% （15/26）,23. 1% （7/26） and 7.7% （2/26）, respectively. Among 16 dead patients, two died of lung metastasis, five died of gastrointestinal bleeding, six died of liver failure, and one die

关 键 词：癌 肝细胞 门静脉 肝瘤循环细胞 支架 碘放射性同位素 化学栓塞 治疗性 

分 类 号：R735.7[医药卫生—肿瘤]