肝癌合并门脉癌栓的超选择化疗栓塞的疗效观察

Superselective intraarterial chemoembolization therapy in medium-end stage hepatocellular carcinoma with tumor thrombus of portal vein

目的评价中晚期肝癌合并门脉癌栓的超选择化疗栓塞疗效。方法肝癌合并门脉癌栓45例患者治疗资料回顾性分析,均有B超,CT,血管造影证实;经肝动脉行超选择灌注化疗和碘油或/和明胶海绵细粒栓塞。结果复查证实肿块缩小大于50%占13.33%(6/45),在25%～50%之间占24.44%(11/45),不变占44.44%(20/45),增大占17.78%(8/45)。门静脉癌栓治疗后改变:消失24.44%(11/45),缩小40%(18/45),不变35.56%(16/45)。生存期:6个月57.78%(26/45),1年35.56%(16/45),2年15.56%(7/45),3年2.22%(1/45)。结论肝癌合并门脉癌栓病人,如肝功能良好,体质能耐受,均应积极进行经肝动脉超选择灌注化疗栓塞,以延长病人生存期。

Objective To evaluate the effectiveness of superselecti ve intraarterial chemoembolization therapy in patients of medium-end stage hepat ocellular carcinoma with tumor thrombus of portal vien . Methods Retrospectiv e study were given to 45 patients with hepatocellular carcinoma with tumor throm bus of portal vein. All the tumor thrombus were confirmed by ultrasonography, co mputed tomography or angiography. All received hepatic arterial chemoembolizatio n with lipiodol and(or) gelfoam. Results >50% tumor size reduction was seen in 13.33% ( 6/45) of patients, 25% ～ 50% was seen in 24.44% ( 11/45) , no significant change in 44.44% ( 20/45) , tumor enlargement was observed i n 17.78% ( 8/45) .The disappearance rate of portal vein tumor thrombus was 24 .44% ( 11/45) , reduction rate 40% ( 18/45) , no significant change 35.56 % ( 16/45) . The 6,12,24 ,36 month survival rates were 57.78% , 35.56% ( 16/45) , 15.56% ( 7/45) , 2.22% ( 1/45) , respectively. Conclusion It seems that hepatocellular carcrinoma with tumor thrombus of portal vein should be actively treated with hepatic arterial chemoembolization, as long as they hav e acceptable liver function and can endure the procedure, in order to get a prol onged survival time.