超声引导门静脉联合肝动脉注射无水酒精治疗门静脉癌栓的研究  

Study of ultrasound-guided percutaneous ethanol injection into portal vein and hepatic artery in treatment of portal vein tumor thrombosis

作　　者：林礼务[1] 林学英[1] 高上达[1] 何以敉[1] 薛恩生[1] 俞丽云[1] 林晓东[1] 

机构地区：[1]福建医科大学附属协和医院超声科福建省超声医学研究所,福州350001

出　　处：《中华超声影像学杂志》2004年第3期195-198,共4页Chinese Journal of Ultrasonography

基　　金：福建省科委研究基金 (2 0 0 0Z1 38)

摘　　要：目的　探讨超声引导门静脉联合肝动脉注射无水酒精 (PEI)对门静脉癌栓 (PVTT)的治疗效果。方法　原发性肝癌 (HCC)合并PVTT 3 4例 ,其中行单纯门静脉穿刺PEI治疗PVTT 19例 (A组 ) ,行门静脉、肝动脉联合PEI治疗PVTT 15例 (B组 )。全部病例同时行肝内肿瘤结节PEI治疗。随访 1～ 3年 ,统计A、B两组治疗后PVTT消失缩小率、甲胎蛋白 (AFP)下降率与 1～ 3年生存率。结果　B组的癌栓消失、停止发展率以及总有效率分别为 5 3 .3 %、3 3 .3 %与 86.6% ,与A组 (分别为 3 6.8%、3 6.8%与73 .6% )比较差异无显著性意义 (P >0 .0 5 )。 3 4例PVTT中AFP升高 2 8例 ,经超声引导治疗后 ,89.2 %( 2 5 /2 8)AFP呈不同程度的下降 ,B组AFP降为正常者高达 75 .0 % ( 9/12 ) ,明显高于A组的 3 7.5 % ( 6/16)(P <0 .0 5 )。B组 1、2、3年生存率分别为 86.7% ( 13 /15 )、69.2 % ( 9/13 )与 44 .4% ( 4 /9) ,均明显高于A组的 3 2 .6% ( 11/19)、2 7.3 % ( 3 /11)与 0 (均P <0 .0 5 )。结论　本研究表明采用超声引导门静脉与局部肝动脉PEI治疗PVTT有一定疗效 ,且 1～ 3年生存率优于单纯门静脉穿刺PEI治疗PVTT ,值得临床进一步探讨。Objective To probe the efficacy of ultrasound-guided percutaneous ethanol injection into portal vein and hepatic artery (double PEI) in treatment of portal vein tumor thrombosis (PVTT). Methods Thirty-four cases of hepatocellular carcinoma(HCC) with PVTT were divided into two groups: A group and B group. Nineteen cases of A group were administered percutaneous ethanol injection into portal vein (PPEI) only and 15 cases of B group were administered double PEI. All the cases were administered PEI in treatment of intrahepatic nodules at the same time and followed 1-3 years. Disappearing and shrinking rates of PVTT, decreasing rate of AFP and survival rates of 1, 2, 3 years of each group were calculated. Results The disappearing, shrinking and total efficacy rates of PVTT of B group were 53.3%, 33.3% and 86.6%, respectively, those of A group were 36.8%, 36.8% and 73.6%, respectively, there were no significance differences between two groups(P> 0.05). Among 28 cases with increasing alpha fetoprotein(AFP), AFP in 25 cases( 89.2%) descended in different degree after ultrasound interventional therapy. AFP in 9 of 12 cases( 75.0%) of B group descended to normal level, while AFP in 6 of 16 cases( 37.5%) of A group descended to normal (P< 0.05). The 1, 2, 3 years survival rates of B group were 86.7% (13/15), 69.2%(9/13) and 44.4%(4/9), respectively, apparently higher than those of A group, which was 32.6%(11/19), 27.3%(3/11) and 0, respectively (All P< 0.05). Conclusions It has certain efficacy to adopt double PEI treating PVTT and its 1, 2, 3 years survival rates are markedly higher than those of PPEI. It worths further probing.

关 键 词：超声引导 门静脉注射 肝动脉注射 无水酒精 联合治疗 门静脉癌栓 

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