介入治疗肝癌伴门脉癌栓的若干问题

The Role of Interventional Treatment on Hepatocellular Carcinoma Combined with Portal Vein Tumor Thrombosis

目的:探讨介入治疗肝癌合并门脉一级分支和或门脉主干癌栓的适应证和治疗方法。方法:25例原发性肝癌合并门脉一级分支和(或)门脉主干癌栓患者接受动脉化疗栓塞术(TACE),部分患者同时接受门脉支架置放术。结果:25例患者分别接受TACE术1～4次,共46次,5例患者放置门脉支架。术后1周Child-Pugh分级11例次由术前A级升至B级,2例次由B级升至C级,1例次由A级升至C级。1例次术后第2天出现肝性脑病。1例患者未完成门脉支架随访、其余4例至患者死亡时支架仍保持通畅。1例患者于6个月失访,其余24例生存期3～15个月,平均6.4个月。结论:TACE和门脉支架置放治疗肝癌合并门脉一级分支和(或)门脉主干癌栓是安全有效的方法,但必须严格掌握适应证和治疗方法。

Objective： To study the indication and method of interventional treatment on hepatocellular carcinoma combined with portal trunk and/or first level branch tumor thrombosis. Methods： 25 patients with primary liver cancer combined with portal trunk and/or first level branch tumor thrombosis received transcatheter arterial chemoembolization, and partial of them received portal vein stent deployment. Results： A total of 46 procedures were performed in 25 patients, and portal vein stent were deployed in 5 patients. One week after the procedure, 11 cases elevated from A to B, 1 case elevated from A to C, and 2 cases elevated from B to C according to Child-Pugh classification scheme. One patient developed hepatic encephalopathy 2 days after the procedure. Patency of portal vein stent was maintained until death in 4 patients, 1 patient was lost follow-up. Surival time ranged from 3 to 15 months （mean： 6.4 months）. Conclusion： TACE and portal vein stent deployment are safe and effective treatment on primary liver cancer combined with portal trunk and/or first level branch tumor thrombosis, on condition that we have the pr0oper indication and method.