【摘要】 目的探讨经皮肝门静脉内支架植入术(PTPVS)联合肝动脉化疗栓塞(TACE)治疗肝癌伴门静脉癌栓的临床疗效及安全性,并探索影响疗效的因素。方法 2009年1月-2010年10月在已临床确诊为肝癌伴门静脉癌栓患者中,按要求筛选病例62例,采用对照、非随机方法分为治疗组和对照组,对照组30例单接受TACE治疗;治疗组32例先接受PTPVS再行TACE治疗,其中2例病例放置门静脉支架未成功。评价指标为总生存时间和安全性。随访患者生存时间,并记录PTPVS术后并发症。用Kaplan-Meier生存分析法分析患者生存时间,两组间生存时间比较用Log-rank法检验;用Cox比例风险回归模型探讨影响患者临床预后的因素。结果治疗组中位总生存期为6.5个月,对照组中位总生存期为4.5个月(治疗组风险比为0.570,95%CI为0.328～0.992,P=0.037),两组间差异有统计学意义(P<0.05)。治疗组30例患者在3、6、12和18个月积累生存率分别为70%、56.7%、10%、3.3%。治疗组在术后1周内未出现手术相关并发症,远期出现的并发症有肝性脑病(2例,6.6%)、上消化道出血(呕血或黑便,3例,10%)、肝肾综合征(1例,3.3%)。结论在肝癌合并门静脉一级分支或(和)门静脉主干不完全闭塞癌栓患者中,PTPVS联合TACE治疗组中位生存期比单独TACE治疗组延长约2个月。治疗方案的安全性较好。更多还原

【Abstract】 Objective to investigate the clinical effect and safety of percutaneous transhepatic portal vein stent placement(PTPVS) combined with transcatheter arterial chemoembolization(TACE) for the treatment of hepatocellular carcinoma(HCC) complicated by tumor thrombus in portal vein,and to discuss the possible factors affecting the prognosis.Methods According to the inclusion criteria and exclusion criteria,62 patients with clinically-confirmed HCC associated with portal vein tumor thrombus,who were encountered during the period from January 2009 to October 2010 in authors’ hospital,were enrolled in this prospective two-arm nonrandomized trail.These patients were randomly divided into study group(n = 32) and control group(n = 30).Simple TACE(THP 40 mg/m2,Oxaliplatin 135 mg/m2,mitomycin C 6 mg/m2,lipiodol 5-20 ml) was used in patients of control group,while PTPVS with subsequent TACE was employed in patients of study group.PTPVS failed in two patients of study group.The overall survival time and the safety were used as the evaluation indexes.All patients were followed up.The procedure-related complications occurred after PTPVS were recorded.A data base on clinical information and follow-up outcome of all patients was set up and SPSS13.0 was used for statistical analysis.Median survival time and survival curve of the patients were analyzed by Kaplan-Meier method.A log-rank analysis was performed to identify group differences.Cox’s proportional hazards model was used to analyze the variables affecting the patients’ prognosis.Results The median overall survival time of the study group was 6.5 months,while the median overall survival time of the control group was 4.5 months(hazard ratio in the study group: 0.57,95%,confidence interval: 0.328-0.992,P = 0.037).Significant difference in the median overall survival time existed between the two groups.The cumulative survival rates at 3,6,12 and 18 months in the study group were 70%,56.7%,10% and 3.3%,respectively.In the study group,no procedure-related complications occurred within 1 week after the operation.The long-term complications in the study group included hepatic encephalopathy(n = 2,6.6%),upper gastrointestinal hemorrhage such as hematemesis and melen(n = 3,10%) and hepatorenal syndrome(n = 1,3.3%).Conclusion For the treatment of patients with HCC complicated by partial obstruction of the main trunk or the rst-order branch of the portal vein due to tumor thrombus,PTPVS combined with TACE is safe and effective.this combination therapy can improve The median survival time of patients receiving this combination therapy is about two months longer than that of patients receiving TACE alone.更多还原