^(125)I粒子条联合门静脉支架及化疗栓塞治疗原发性肝癌合并门静脉癌栓

Linear ^(125)I seed strand implantation combined with portal vein stenting and TACE for the treatment of hepatocellular carcinoma with portal vein tumor thrombus

目的评估125I粒子条联合金属支架门静脉内植入+动脉化疗栓塞治疗原发性肝癌合并门静脉主干癌栓的疗效。方法选取17例原发性肝癌伴门静脉主干癌栓患者,行125I粒子条联合门静脉内支架+TACE。粒子植入数量17～23粒(6711型,0.7mCi/粒),第1个半衰期组织内平均吸收剂量为73.51～76.22Gy。疗效和不良反应评价指标包括:术后并发症,肝肾功能及血常规改变等。采用Kaplan-Meier生存曲线分析患者的生存时间、支架通畅时间、累积生存率和累积支架通畅率。结果所有患者门静脉支架和125I粒子条均成功植入,未发生手术相关严重并发症。术后随访2～13个月,12例存活,5例死亡(肝功能衰竭4例,多发转移1例)。60、180和360d的累积支架通畅率为94%、94%和94%;累积生存率为87%、65%和53%。结论125I粒子条联合金属支架门静脉内植入+动脉化疗栓塞治疗原发性肝癌合并门静脉主干癌栓可以提高支架通畅率,延长生存时间。但远期效果尚需进一步观察。

Objective To evaluate the therapeutic efficacy of linear 125I seed strand implantation combined with portal vein stenting and transcatheter hepatic arterial chemoembolization （TACE） in treating hepatocellular carcinoma （HCC） with portal vein tumor thrombus. Methods Seventeen HCC patients with tumor thrombus in the main branch of the portal vein received a combination therapy of linear 125I seed strand implantation with TACE. A total of 17 - 23 seeds of 125I （model 6711, 0.7 mCi） with a dosage of （73.51- 76.22） Gy on the first half-decay period was delivered to each patient. The postoperative complications, tumor response, stent patency rate and the successful rate of the procedure were all recorded, and the Kaplan-Meier method was used for analyzing the survival rate. Results Stents and 125I seed strands were successfully placed in the portal veins in all patients. No serious complications occurred. The 60-, 180- and 360-day cumulative stent patency rates were 94%, 94% and 94% respectively, and the overall survival （OS） rates were 87%, 65% and 53% respectively. During a follow-up period of （2 - 13） months, twelve patients remained alive and five patients died of hepatic dysfunction （n = 4） or metastasis （n = 1）. Conelusion For the treatment of hepatocellular carcinoma with portal vein tumor thrombus, a combination of linear 125I seed strand implantation with portal vein stenting and TACE can increase the stent pateney rate, elongate the survival span, although its long-term efficacy needs to be further studied.