【作者】 胡鸿涛； 黎海亮； 郭晨阳； 姚全军； 孟艳莉； 程洪涛； 郑琳； 杨辉； 李文亮；

【Author】 HU Hong-tao*,LI Hai-liang,GUO Chen-yang,YAO Quan-jun,MENG Yan-li,LUO Jun-peng,CHENG Hong-tao,YANG Hui,LI Wen-liang.*Department of Radiology,Department of Nuclear Medicine,Henan Cancer Hospital,Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China

【机构】 河南省肿瘤医院； 郑州大学附属肿瘤医院放射科；

【摘要】 目的探讨125 I粒子结合动脉化学栓塞治疗原发性肝癌伴门静脉癌栓的临床价值。方法回顾性分析不能行手术治疗的原发性肝癌伴Ⅱ型或Ⅲ型门静脉癌栓的23例患者的临床资料,男20例,女3例;年龄34～70岁,平均(56±8)岁;肝内原发肿瘤1～15个(中位数为4个)。23例门静脉癌栓的平均直径为(20.5±1.5)mm,平均长度为(37.4±2.6)mm。所有患者均行动脉化学栓塞治疗肝内原发病灶联合经皮穿刺门静脉癌栓内125I粒子植入治疗门静脉癌栓。125 I粒子植入的方法为:通过治疗计划系统计算出处方剂量、所需粒子数、粒子的空间分布、粒子放射性活度、匹配周边剂量等参数,然后在CT监视下,依次在肿瘤的不同层面及位置植入125I粒子。结果动脉化学栓塞治疗次数1～6次,平均(3.1±0.4)次;门静脉穿刺粒子植入次数1～2次,平均(1.4±0.5)次;植入粒子数4～17枚,平均(7.0±1.0)枚。患者生存期为3～24个月,中位生存期为18个月。患者3、6和12个月生存率分别为91.3%(21/23)和69.6%(16/23)和60.9%(14/23)。所有患者均未见与治疗相关的严重并发症发生。结论 125I粒子植入联合动脉化学栓塞治疗可以显著延长伴有门静脉癌栓的原发性肝癌患者的中位生存期。更多还原

【Abstract】 Objective To assess the therapeutic value of transcatheter arterial chemoembolization combined 125iodine seed implantation for portal vein tumor thrombosis in primary hepatic carcinoma with portal vein tumor thrombus.Methods Twenty-three patients with primary hepatic carcinoma with portal vein tumor thrombosis of typeⅡand typeⅢ.The patients’ age ranged from 34 to 70 years old[average age(56±8)years]and the tumor number of liver parenchyma were 1 to 15(median number 4).The average diameter of tumor thrombus was(20.5±1.5) mm and average length was(37.4±2.6) mm in all of the 23 patients.All of the tumor of liver parenchyma in 23 patients were treated by transcatheter arterial chemoembolization(TACE) and tumor thrombus were treated by 125iodine seed implantation.Before the 125iodine seed implantation,the formula dosage,the number,the spatial distribution,the intensity of radioactivity and the matched peripheral dosage of seed were calculated by treatment planning system(TPS).After these preparation,the 125iodine seeds were implanted in different deck and location of port vein thrombosis under CT guided.Results The follow up period was range from 1 to 26 months.The time of transcatheter arterial chemoembolization was 1 to six times(median time 3.1±0.4) and the 125iodine seed implantation in the port vein thrombosis was 1 to 2 times(median time 1.4±0.5).The number of implanted 125iodine seeds were 4 to 17(median number 7.0±1.0).The median survival time was 18.0 months(3-24 months).The 3,6 and 12 months survival rates were 91.3%(21/23),69.6%(16/23) and 60.9%(14/23).There was no severe side-effect related to therapy observed in all patients.Conclusions Transcatheter arterial chemoembolization combined 125iodine seed implantation for portal vein tumor thrombosis could significantly prolong the median survival time of patient with primary hepatic carcinoma accompanied by portal vein tumor thrombosis.更多还原