【作者】 李文涛； 彭卫军； 董生； 贾宁阳； 欧阳强严；

【Author】 Li Wen-Tao Peng Wei-Jun Dong Sheng Jia Ning-Yang Dept. Radiology , Cancer Hospital, Fudan University Dept. Radiology , Changzheng Hospital , Second Military University , Shanghai 200032 , P. R. China

【机构】 复旦大学附属肿瘤医院放射诊断科； 第二军医大学长征医院影像科；

【摘要】 目的:探讨肝癌合并门静脉癌栓的门静脉金属内支架结合 TACE治疗的临床效果。方法:研究对象:肝癌伴门脉癌栓患者11例,男9例,女2例,年龄37—74岁,平均57．4岁。所有患者均伴有不同程度的肝硬化、食管胃底静脉曲张。肝功能分级Child A 4例,Child B 7例。肿瘤位于右叶4例,左叶6例,累及两叶1例,皆为巨块型。门脉癌栓造成门静脉右支阻塞累及分叉4例,左支阻塞累及分叉6例;左支或右支阻塞合并门静脉主干狭窄1例;主干狭窄程度30％-90％。影像学检查证实无其它脏器转移。方法彩超导引下经皮穿肝门静脉成功后行门静脉造影,判断癌栓累及程度,选择合适的支架置放。支架采用镍钛记忆合金支架,共10枚,中、重度食管胃底静脉曲张行栓塞术,穿刺道采用明胶海绵和／或不锈钢圈堵塞。所有患者同时或1周后行肝动脉插管化疗栓塞治疗,根据每个患者的术后复查的具体情况,施行个体化的TACE治疗。结果:门静脉通路穿刺成功率100％,经皮穿刺门静脉右支静脉分支7例,穿刺门脉左支4例,11例共置放10枚支架(其中1例因癌栓累及门脉左右分支且门脉主干内血栓形成,狭窄段较长而放弃内支架治疗),支架置放成功率90．9％。10例支架释放均为开通非肿瘤所在肝叶门脉分支与门脉主干。所有病例未见因穿刺所致并发症。1例门脉支架结合TACE术后3 天发生肝功能衰竭死亡。所有患者发生不同程度的腹痛,发热,肠胀气。11例获随访。支架通畅期为1-18个月,支架中位通畅期5．7个月,治疗后3个月、6个月、1年患者生存率分别为45．4％(5／11)、36．4％(4／11)、18．2％(2／11) 。11例死亡,死亡原因:肿瘤进展7例,上消化道大出血1 例,肝功能衰竭、肝性脑病1例,肝肾综合征2例。结论: 巨块型肝癌合并门静脉癌栓,无远处广泛转移的患者采用支架开通门脉主干与远端为非肿瘤所在肝叶的门脉,结合 TACE 治疗,可取得较好的疗效。更多还原

【Abstract】 Objective: To discuss the clinical efficiency of stenting in portal vein associated with TACE for portal vein tumor thrombus in the patients with primary hepatic carcinoma (PHC) . Methods: Tumor thrombus in the main branch and trunk of the portal vein in 11 cases with PHC, nine of the patients were men and 2 were women. The mean age of the patients was 57.4 years (range, 37-74 ys). The diagnosis of malignant portal vein invasion was based on the results of diagnostic imag- ing studies, such as abdominal ultrasonography (US) including Doppler studies, contrast-enhanced computed to-mography (CT), angiography and percutaneous transhepatic portography . Stenosis or obstruction of the portal venous system surrounded by tumor was considered to be indicative of portal vein invasion. All patients had hepatocellular carcinoma invading the intrahepatic and main portal veins. The mean size of intrahepatic tumors was 13.4 cm (range, 7-0 cm). Tumors invaded the right portal veins and the junction of the two veins (left branches partial involvement ) in four patients, left branches occlusion and main portal veins involvement in four patients, and in one patient at the junction of the two branches. All patients were treated with portal vein stentings associated with TACE right now or 1 week later. The successful rate of the procedure, the patency rate of the portal vein stents , the complications , the mortality and the survival period were recorded. Results: The procedure was successfully performed in 11 cases , The obstruction was reopened in 90.9 % of cases. Hepatic en-cephalopathy and hepatic failure occurred in one cases.更多还原