原发性肝癌合并肝静脉、下腔静脉或右心房瘤栓的诊治

Diagnosis and treatment of primary liver carcinoma with tumor thrombus extended into hepatic vein and inferior vena cava or right atrium

目的探讨原发性肝癌合并肝静脉瘤栓(HVTT)、下腔静脉瘤栓(IVCTT)或右心房瘤栓(RATT)的影像学特点和介入、手术切除的治疗效果。方法对20例肝癌患者的临床资料进行总结和分析。结果HVTT+IVCTT+RATT9例,HVTT+IVCTT9例,HVTT+RATT1例,IVCTT+RATT1例。16例行肝动脉造影,提示15例瘤栓为肝动脉供血。15例行肝动脉化疗栓塞,其中2例行Ⅱ期切除+IVCTT摘除术,1例介入前行肝癌局部高温固化术。生存时间为7d^75个月,中位生存期为10个月。结论HVTT、IVCTT和RATT的诊断主要依据综合影像学检查。由于瘤栓的肝动脉供血的特点,肝动脉化疗栓塞可使其坏死、缩小甚或消失。对肝癌病灶较局限、肝功能良好和肺部无转移的患者,肝动脉化疗栓塞可明显延长其生存期。少数患者可争取Ⅱ期切除。

Objective To explore the imaging characteristics and therapeutic effect of hepatic liver cancer complicated with hepatic vein （ HV ） ,inferior vena eava （ IVC ）, or right atrium （ RA ） tumor thrombus （TT）. Methods The clinical data of 20 cases of hepatic cancer were analyzed. Results There were 9 cases with HVTT ＋ IVCTT ＋ RATT,9 with HVTT＋ IVCTT,I with HVTT ＋ RATT and 1 with IVCTT ＋ RATE 15 of 16 cases undergoing hepatic artery angiography demonstrated that the blood supply of the tumor thrombus was from the hepatic artery. 15 cases underwent one or more times of TACE,2 cases underwent subsequent hepatotectomy ＋ the resection of IVCTT. One patient had a regional hyperthermal solidification of the hepatic lesion prior to TACE. The survival term for the 15 patients ranged from 7 days to 75 months with a mean time of 10 months. Conclusion Combined image examinations are required for the diagnosis of primary liver carcinoma with HVTT,IVCTT or RATT. TACE can prolong the survival time for the patients who are of good hepatic function and have no diffuse lung metastases and -also provide a chance of subsequent surgical resection for some patients.