门静脉支架联合^(125)I粒子条植入治疗门脉癌栓12例  

Portal vein stenting combined with ^(125)I strand implantation for the treatment of portal vein tumor thrombus: initial results in 12 patients

作　　者：毛晓楠[1] 卢再鸣[1] 郭启勇[1] 

机构地区：[1]中国医科大学附属盛京医院放射科,沈阳110022

出　　处：《介入放射学杂志》2016年第12期1058-1064,共7页Journal of Interventional Radiology

摘　　要：目的介绍用门静脉支架联合125I粒子条对合并门脉癌栓的肝癌患者的综合治疗方法。方法汇集自2014年以来中国医科大学附属盛京医院放射科收治的肝癌合并门脉癌栓的患者12例,分析其临床、影像、实验室检查资料,完成经皮经肝门静脉穿刺及支架联合125I粒子条植入术,统计手术的可行性、安全性及并发症,讨论支架的通畅情况及患者的生存情况。结果手术成功12例(100%),2例支架未开通,其中1例并发穿刺点出血,1例并发呕血。10例患者接受随访,平均随访时间8.0个月(2~15个月),平均生存时间8.0个月(2~15个月)。术后3、6和9个月及1年生存率分别为7/9、7/9、5/8和3/6。门脉支架平均通畅时间7.5个月(0~15个月)。术后3、6和9个月、1年门静脉通畅率分别为7/9、6/9、5/8和3/6。随访期内共8例患者行后续TACE治疗,共行TACE 18例次,术后肝功能稳定。结论门静脉支架联合125I粒子条植入可以降低癌栓分级、维持支架通畅、保证门脉供血、扩大TACE适应证,对合并门脉癌栓的肝细胞癌患者具有较大的综合治疗价值。Objective To introduce the combination therapy of portal vein stenting plus ^125I strand implantation for the treatment of portal vein tumor thrombus （PVTY） in patients with hepatocellular carcinoma （HCC）. Methods A total of 12 HCC patients associated with PVTr, who were admitted to the Department of Radiology, Shengjing Hospital, China Medical University from 2014 to the end of this study, were collected. The clinical information, imaging materials and laboratory test data were retrospectively analyzed. All patients received percutaneous transhepatic portal vein puncture with portal vein stenting and ^125I strand implantation. The feasibility, safety and complications of the operation were statistically analyzed, and the patency of the stents and the survival of the patients were discussed. Results The interventional procedures were successfully accomplished in all the 12 patients （100%）. Stent occlusion was seen in 2 patients and puncture point bleeding in one patient. Ten patients were followed up, the mean follow-up time was 8.0 months （2-15 months）, the mean survival time was 8.0 months （2-15 months）. The 3-, 6-, 9-, and 12- month survival rates were 77.8% （7/9）, 66.7% （6/9）, 62.5% （5/8） and 50.0% （3/6） respectively. During the follow-up period, 8 patients received further TACE treatment, and a total of 18 TACE procedures were performed. After the treatment, the hepatic function remained in stable condition. Conclusion Portal vein stenting plus ^125I strand implantation can reduce the grade of tumor thrombus, maintain the patency of stent and ensure adequate portal blood supply. This therapy has expanded the range of TACE indications, and it has high value of comprehensive treatment for patients with HCC complicated by portal vein tumor thrombus.

关 键 词：门静脉 癌栓 支架 ^125I 

分 类 号：R735.7[医药卫生—肿瘤]