经皮经肝选择性门静脉栓塞化疗术在原发性肝癌合并门静脉癌栓治疗中的应用

PERCUTANEOUS PORTAL VEIN CHEMOEMBOLIZATION IN THE TREATMENT OF PRIMARY HEPATIC CARCINOMA WITH PORTAL VEIN TUMOR THROMBUS

目的探讨选择性门静脉栓塞化疗对原发性肝癌的治疗效果。方法对38例合并门静脉瘤栓的原发性肝癌患者在行肝动脉栓塞化疗（TAE）基础上，联合应用经皮经肝选择性门静脉栓塞化疗术（SPVE）。33例为块状型，5例为结节型，其中直径大于10cm24例，5～10cm11例，小于5cm3例，肿瘤位于肝右叶29例，肝左叶6例，左右叶3例。血清AFP检测＞400ug／L21例，在200ug／L～400ug／L之间6例，（一）／＜200ug／L11例。门静脉瘤栓位于右支19例，左支者7例，右支＋主干6例，左支＋主干2例，左右支＋主干4例。结果治疗后门静脉瘤栓消失和缩小率为68．4％，肿瘤缩小率为76．3％，AFP转阴14例，4例呈一过性转阴或下降，总有效率为85．7％。9例获二期手术切除，术后病理证实，门静脉癌栓坏死率100％。术后随访，1年，3年存活率分别为73．7％和18．4％，远比单纯TAE治疗组高。结论选择性门静脉栓塞化疗是治疗肝癌合门静脉癌栓的有效方法。

To study the effect of percutaneous selective portal vein embolization (SPVE) on primary hepatic carcinoma. Methods 38 cases of primary hepatic cancer with portal vein tumor thrombus underwent percutaneous selective portal veinembolization (SPVE) in combination with TAE. 33 cases were mass type,and 5 nodule,with diameter of tumors in 24 cases biggerthan 10cm, 3 smaller than 5cm, 11 in between. There were 29 cases with tumors situated in right lobes, 6 in left lobes, 3 in bothlobes. The serum AFP examination showed 21 cases higher than 400ug/L, 11 cases lower than 200ug/L, 6 cases between 200ug/Land 400ug/L. Ultrasound and CT examination indicated portal thrombus located in right branches in 19 cases,in left in 7 cases,inright and trunks in 6 cases,in left and trunks in 2 cases,in right and left and trunks in 4 cases. Results The rate of disappearpnceand shrinkage of portal vein tumor thrombus was 68. 4%,and tumor shrinkage rate 76. 3 a,AFP negative--reversion rate 85. 7%.Among them, 9 cases underwent hepatectomy after receiving SPVE and TAE treatment. The post--operative pathological examination approved that the necrosis rate of portal vein tumor thrombus was 100%. The follow--up survey revealed that I --and 3--yearsurvival rates were 73. 7% and 18. 4% respectively,far better than that for TAE group. Conclusion SPVE is an very effectiveway in the treatment of primary hepatic cancer with portal vein tumor thrombus.