经皮门脉射频消融导管消融联合肝动脉化疗栓塞治疗肝癌伴Ⅲ型门静脉癌栓的临床疗效  

Clinical analysis of Percutaneous radiofrequency ablation combined with TACE in treatment of hepatocellular carcinoma with Type Ⅲ portal vein tumor thrombus

作　　者：梁军[1] 葛乃健 过欣来 杨永康 唐庆贺 LIANG Jun;GE Naijian;GUO Xin-lai(The Eastern Hospital,Shanghai 200436,China)

机构地区：[1]同济大学附属上海东方医院肝胆胰外科,上海200436 [2]海军医科大学附属东方肝胆外科医院介入科

出　　处：《肝胆外科杂志》2020年第5期345-348,共4页Journal of Hepatobiliary Surgery

基　　金：上海市卫健委面上项目(201540310)资助。

摘　　要：目的观察采用血管内射频消融(radiofrequency ablation,RFA)联合肝动脉化疗栓塞(transcatheter arterial che-moembolization,TACE)治疗Ⅲ型门静脉癌栓的安全性和疗效。方法12例肝癌合并Ⅲ型门静脉癌栓并出现血流阻塞的患者,结合B型超声及DSA引导,将新型血管内RFA导管导引至门静脉癌栓处消融治疗,续贯行肝肿瘤TACE术。评价手术成功率、术后并发症、肝肾功能及血常规改变、门静脉通畅及癌栓消融情况。结果所有患者均顺利完成手术,未发生如穿刺道出血、血管穿孔胆汁瘘并发感染、肝脓肿腹腔出血等并发症,RFA后直接门静脉造影显示局部门静脉再通;4周后复查肝功能、血常规无明显变化,超声多普勒检查提示原堵塞门静脉有血流通过部分患者CT检查见门静脉癌栓缩小或消失。结论经皮门脉射频消融导管消融门脉癌栓结合TACE在技术上具有可行性,治疗肝癌合并门静脉癌栓的一种有效方法。Objective To investigate the safety and elinical efct of endovascular radiofrequency ablation(RFA)combined with TACE in treating of TypeⅢportal vein tumor thrombus.Methods Twelve patients of hepatocellular careinoma associated with TypeⅢportal vein thrombus causing obstruction of blood flow were erolld in this study.Guided by ultrasound and DSA the percuta-neous portal catheter was this study.Guided by ultrasound and DSA the percutaneous portal catheter was implanted into portal vein tumor thrombus and the RFA was performed.TACE was conducted afterwards.The technical success rate,the postoperative complica-tions,the hepatic and renal functions as well as routine blood tests,portal vein blood flow and the ablation extent of portal vein tumor thrombus were evaluated,and the results were analyzed.Results The procedure was sccessfully accomplished in all patients.No RFA-related complications,such as hemorrhage,vessel perforation,bile leak,liver abscess,abdominal bleeding occrred.The instant portography showed that the portal vein was unobstructed.Blood testing 4 weeks after RFA showed that no significant changes in hepat-ic funetions and blood count were observed.Doppler ultrasound showed the blood flowing in previously obstructed portal vein.CT scan indicated that the portal vein tumor thrombus was reduced in size or even disappeared.Conclusion Combined treatment with RFA and TACE is feasible and ffective to those who diagnosed as HCC with TypeⅢPVTT.

关 键 词：血管内射频消融 经皮肝穿刺门静脉造影术 门静脉癌栓 肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]