经导管化疗栓塞治疗原发性肝癌合并下腔静脉癌栓

Primary hepatic carcinoma with tumor thrombus in inferior vena cava： treated by transcatheter chemoembolization

目的评价经导管化疗栓塞治疗原发性肝癌合并下腔静脉（IVC）癌栓的临床疗效和安全性。方法9例原发性肝癌合并IVC癌栓患者，诊断均经穿刺病理证实为肝细胞肝癌，单发癌灶3例，2～3个癌灶4例，3个以上癌灶2例，癌灶最大径3．5～8．6cm，平均（5．6±1．7）cm，行经导管化疗栓塞治疗。化疗栓塞采用化疗药物-碘化油混合乳剂，进行化疗栓塞的血管包括：肝动脉分支、右侧膈下动脉、胃左动脉等。随访通过上腹部、肺部CT及实验室检查，随访时间7—38个月。结果9例患者共行17次介入治疗，所有治疗均获成功，无明显并发症。随访期内死亡3例，生存期最长的1例已达38个月。结论对原发性肝癌合并IVC癌栓的患者实施经导管化疗栓塞治疗安全可行，可以延长患者的生存时间，并提高生活质量。

Objective To evaluate the efficacy and the safety of the interventional radiology treatment for primary hepatic carcinoma （PHC） combined with tumor thrombus in inferior vena eava （ IVC ）. Methods Transcatheter chemoembolization were performed on 9 cases of PHC with tumor thrombus in IVC. The diagnosis was established by puncture biopsy, including single lesion in 3 cases, 2--3 lesions in 4 cases, more than 3 lesions in 2 cases. The tumors ranged in maximum diameter from 3.5--8. 6 cm with a mean of （5.6 ± 1.7 ） em. All the patients were treated with the ehemotherapeutics-lipiodol mixture and the treated arterials included the hepatic arterial, the right inferior phrenic arterial and the left gastric arterial. Follow-up was performed by upper abdomen CT, lung CT and laboratory examination, and follow-up time ranged from 7 to 38 months with a mean of （14.9± 9. 9 ） months. Results Seventeen interventional procedures were performed on 9 patients and all operations were successful without significant complications. The average survival time of 9 cases was（ 14.9 ±9.9 ）months （ranged from 7 months to 38 months） , and the longest survival time was 38 months. Conclusions Transeatheter chemoembolization can be safely performed on the cases of PHC combined with tumor thrombus in IVC. Interventional treatment can prolong the survival time and promote the quality of life.