^(125)I粒子条联合血管支架植入治疗原发性肝癌合并门脉癌栓17例  

^(125)I particle strip combined with vascular stent implantation for the treatment of primary hepatocellular carcinoma associated with portal vein tumor thrombus:clinical results in 17 patients

作　　者：杨胜利[1] 顾俊鹏[1] 曹耿飞 张海潇[1] 朱帝文[1] 鲍应军 纪卫政[1] 任伟新[1] YANG Shengli;GU Junpeng;CAO Gengfei;ZHANG Haixiao;ZHU Diwen;BAO Yingjun;JI Weizheng;REN Weixin(Department of Interventional Radiology,First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang Uygur Autonomous Region 830054,China)

机构地区：[1]新疆医科大学第一附属医院介入放射科,乌鲁木齐830054

出　　处：《介入放射学杂志》2021年第7期674-679,共6页Journal of Interventional Radiology

摘　　要：目的探讨^(125)I粒子条联合门静脉血管支架植入治疗原发性肝癌合并门脉癌栓的安全性及疗效。方法回顾性分析2015年2月至2020年1月在新疆医科大学第一附属医院诊疗的17例原发性肝癌合并门脉癌栓患者的临床资料,17例均行经皮穿刺门静脉内^(125)I粒子条联合血管支架植入术。每例患者植入粒子数量10~45粒,粒子活度0.8 mCi/粒,处方剂量100~120 Gy。植入血管支架数量1~2枚。评价指标包括手术成功率、术后并发症、门脉压力改善情况、累计生存率和支架通畅性。结果17例患者手术均获成功。1例术后并发穿刺道出血,1例支架未开通(门脉开通率94.1%)。门脉支架植入前患者平均门脉压力为(35.0±3.0)cmH_(2)O(1 cmH_(2)O=0.098 kPa),支架植入后平均门脉压力为(27.2±5.4)cmH_(2)O,平均下降(7.8±4.3)cmH_(2)O,两组比较差异有统计学意义(P<0.05)。术后15例患者获得随访(2~16个月),4例患者目前生存,其中2例生存时间已超过1年。11例死亡(肝功能衰竭7例,多发转移1例,肝癌结节破裂出血1例,食管胃底静脉破裂出血2例),其中1例最长生存14个月。患者平均生存时间为(209.23±38.38)d(95%CI,134.00~284.46),中位生存时间为(145±19.1)d(95%CI,107.42~182.58)。术后3个月、6个月和1年的累计生存率分别为93.3%、26.7%和20.0%。支架平均通畅时间为(246.87±59.52)d(95%CI,130.21~363.53)。随访期内有9例患者行TACE治疗(共行19例次)。结论^(125)I粒子条联合血管支架植入治疗原发性肝癌合并门脉癌栓安全可行,能降低门脉压力,恢复部分肝脏血流灌注,扩大肝动脉化疗栓塞适应证,有效延长患者生存期。Objective To discuss the safety and efficacy of ^(125)I particle strips combined with portal vein stent implantation in the treatment of primary hepatocellular carcinoma(HCC)associated with portal vein tumor thrombus.Methods The clinical data of 17 patients with primary HCC,who were admitted to the First Affiliated Hospital of Xinjiang Medical University of China during the period from February 2015 to January2020 to receive treatment,were retrospectively analyzed.Percutaneous puncture of portal vein was performed,which was followed by implantation of ^(125)I particle strips and portal vein stent.The implanted ^(125)I particles in each patient was about 10-45 seeds,the particle activity was 0.8 mCi/seed,and the prescribed dose was 100-120 Gy.In each patient 1-2 vascular stents was implanted.The technical success rate,postoperative complications,improvement of portal pressure,cumulative survival rate and stent patency were used to evaluate the safety and efficacy of this therapy.Results Successful operation was accomplished in all the 17 patients.After the surgery,one patient developed puncture tract bleeding and the stent didn’t open in one patient(portal vein opening rate 94.1%).The average pre-stenting portal pressure was(35.0±3.0)cmH_(2)O(1 cmH_(2)O=0.098 kPa),the post-stenting portal pressure was(27.2±5.4)cmH_(2)O,and the mean reduction in portal pressure was(7.8±4.3)cmH_(2)O.The difference was statistically significant(P<0.05).Fifteen patients were able to be followed up for 2-16 months,4 patients were alive so far and 2 of them were alive for more than one year.Eleven patients died of hepatic failure(n=7),multiple metastases(n=1),rupture of HCC nodules with bleeding(n=1)and esophagogastric varices rupture with bleeding(n=2),among them the longest survival time was 14 months(n=1).The average survival time of patients was(209.23±38.38)days(95%CI:134.00-284.46),and the median survival time was(145±19.1)days(95%CI:107.42-182.58).The cumulative survival rates at 3 months,6 months and one year after treatm

关 键 词：门静脉癌栓 ^(125)I粒子条 血管支架 肝癌 

分 类 号：R735.7[医药卫生—肿瘤]