肝细胞癌合并门静脉主干癌栓的DSA表现与介入治疗方案选择

Hepatocellular carcinoma with tumor thrombus in the main portal vein:DSA features and interventional therapeutic strategy

目的分析肝细胞癌(HCC)合并门静脉主干癌栓的肝动脉DSA表现,探讨其对介入治疗方案选择的意义。方法对56例HCC伴门静脉癌栓患者的DSA表现进行分析,并据此制定介入治疗方案。结果14例DSA无肝动脉高灌注异常,其中2例可见门静脉癌栓内肿瘤染色,行常规TACE;19例出现明确肝动脉高灌注异常,但可分辨出肿瘤血管和肿瘤染色灶,行肝固有动脉化疗和肿瘤节段性栓塞;9例全肝叶或全肝有明显肝动脉高灌注异常,仅行肝固有动脉化疗;14例出现肝动脉-门静脉分流,对12例先行瘘口封堵,再给予肿瘤节段性栓塞,2例高流量肝右动脉-门静脉分流未予封堵。术后随访2个月,48例肿瘤体积缩小,7例病灶进展或出现新病灶,未发生肝功能衰竭。结论对HCC合并门静脉癌栓患者,TACE过程中应高度重视分析肝动脉DSA所见,评价肝内动、门静脉血供变化状况,有针对性地合理选择治疗方案。

Objective To analyze the angiographic manifestation of hepatocellular carcinoma （HCC） combined with thrombosis in the main portal vein and its effluence of interventional therapy. Methods Angiographic study was performed for 56 patients of HCC combined with thrombosis in the main portal vein, and different therapeutic regimens were determined according to the characteristics of angiographic manifestation. Results Classic TACE were performed for 14 patients, whose angiogram revealed no hepatic arterial hyperperfusion, while TAI and segmental hepatic arterial chemoembolization were applied to 19 patients with regional hepatic arterial hyperperfusion with discernable tumor vessel and tumor stain. In 9 patients whose angiogram displayed lobar or pan-liver arterial hyperperfusion, Only TAI were performed. In 14 cases with arterial-portal venous shunt, segmental chemoembolization were executed only after the shunt been shut down successfully except for 2 cases with high-flow right hepatic artery-portal vein shunt. All 56 cases were followed up after procedures for 2 months. Tumor regression was observed in 48 patients, while tumor progression was found in 7 patients. No hepatic decompensation occured. Conclusion Angiographic representation should be studied thoroughly before interventional therapy for HCC combined with portal vein thromosis. Correct evaluation of hemodynamic status of hepatic arterial and portal venous system is the key of interventional therapies.