门静脉支架结合经动脉化疗栓塞在肝癌伴门静脉癌栓中的应用价值

Portal vein stenting combined with transcatheter hepatic arterial chemoembolization in treatment of portal vein tumor thrombus in patients with primary hepatic carcinoma

目的:探讨门静脉支架结合经动脉化疗栓塞术(TACE)治疗肝癌伴门静脉癌栓的临床效果。方法:27例肝癌伴门静脉癌栓均采用经皮肝穿门静脉途径植入门静脉支架,1周后行TACE。记录手术成功、狭窄开通、并发症和手术死亡发生情况,随访支架通畅期和患者生存期。结果:门静脉通路穿刺成功率100%(27/27);门静脉支架置入成功率96.3%(26/27);发生肝性脑病3例及肝衰竭4例。支架中位通畅期6个月(1～18个月),治疗后3个月、6个月、12个月以上患者生存率分别为51.85%(14/27)、29.63%(8/27)、18.52%(5/27)。结论:对肝癌伴门静脉癌栓,采用支架开通门静脉主干及分支为非肿瘤所在肝叶的门静脉,结合TACE治疗,可取得较好的疗效。

Objective：To discuss the clinical outcomes of portal vein stenting combined with transeatheter hepatic arterial chemcembolization（TACE） in treating portal vein tumor thrombus in the patients with primary hepatic carcinoma（PHC）. Methods： Twenty-seven PHC patients with tumor thrombas in the main branch or trunk of the portal vein were treated with stenting and TACE was performed one week later. The successful rate of the procedure, the patency of the obstruction, the complications, the mortality, and the survival periods were all recorded.Results：Portal vein puncture was successfully perforated in all 27 cases and successful stenting was achieved in 26 cases. 3 patients presented with hepatic encephalopathy and 4 patients with hepatic. The median patency period after stenting was 6（ 1 - 18） months. The survival rates of patients at 3, 6, 12 months after treatment were 51.85% （14/27）, 29.63% （8/27）, 18.52% （5/ 27）, respectively. Conclusion： Stent in,plantation combined with TACE has satisfactory outcome in treating tumor thrombus inthe main branch and trunk of the portal vein in PHC patients.