TACE对有门脉主干癌栓肝癌患者肝功能的影响及疗效分析

The Effect of TACE on the Liver Function in Patients with Tumor Thrombus in the Portal Vein and the Therapeutic Evaluation of TACE

目的 评价经导管肝动脉化疗栓塞术 (TACE)对有门脉主干癌栓的肝细胞癌 (HCC)患者的肝功能的影响及其疗效分析。资料与方法 回顾分析 2 6例门脉癌栓的HCC患者 (主干癌栓 7例 ,一级分支癌栓 19例 )的TACE ,术前均采用Child Pugh评分和其他肝功能指标评价基础肝功能状态。将导管插至肝叶动脉内共行 5 7次栓塞 (仅用碘油化疗药物乳化剂 )。TACE后 3天、1周、2周和 4周分别再次评价肝功能状态。记录肿瘤缩小情况和患者生存期以评价其疗效。结果 术前所有患者的Child Pugh评分为 5 .731± 1.15 1,TACE后 3天、1周、2周和 4周均有升高 ,分别为 6 .6 92± 1.36 9、6 .6 32± 1.2 4 3、6 .4 82± 1.4 91和 6 .0 38± 1.310 ,与术前比较均有显著性差异 (P分别为 <0 .0 0 1,<0 .0 0 1,<0 .0 1,<0 .0 5 )。TACE后早期Child Pugh评分的升高主要因为血清总胆红素 (TBIL)的升高 ,后期主要与白蛋白 (ALB)的降低以及出现腹水或腹水加重有关。治疗后 8例肿瘤明显缩小 ,12例病灶稳定。 6、12、2 4个月生存率分别为 84 .6 %、4 2 .3%、3.8%。 2例死于急性肝功能衰竭。结论 对于有门脉主干癌栓的HCC ,TACE是有效的治疗方法 ,可以改善患者生存率 ,但也能明显加重肝功能的损害 ,甚至导致急性肝功能衰竭。

Objective To evaluate the effect of transcatheter arterial chemoembolization (TACE) treatment on the liver function in patients with hepatocellular carcinoma (HCC) accompanied with tumor thrombus in the portal vein and to evaluate the therapeutic effectiveness of TACE.Materials and Methods The results of TACE in 26 patients of HCC with portal vein thrombus, located in the portal trunk (n=7) or in the first level branch (n=19), were retrospectively analyzed. Before TACE, baseline liver function was evaluated with Child Pugh scores and other indicators. A total of 57 TACE, using lipiodol anticarcinogen emulsion only, was performed with the catheter tip being placed in lobar arteries. Liver function was re examined at 3 days, 1, 2 and 4 weeks after the procedure. The regression of the tumor and the survival time were recorded to evaluate the therapeutic effectiveness.Results The mean baseline Child Pugh score was 5.731±1.151. After the procedure, the Child Pugh score was increased in all patients to 6.692±1.369 at 3 days, 6.632±1.243 at one week, 6.482±1.491 at 2 weeks and 6.038±1.310 at 4 weeks (P<0.001, <0.001, <0.01 and <0.05, respectively). The increase of Child Pugh scores was mainly due to the elevation of serum levels of total bilirubin (TBIL) in the early days after TACE, while in later period it was correlated with the decrease of albumin (ALB) and the development or exacerbation of ascites. Remarkable regression of the tumor was found in 8 patients, and the lesion was stable in size in 12 patients. The cumulative survival rate at 6, 12 and 24 months was 84.6%, 42.3% and 3.8%, respectively. Two patients died of acute hepatic failure.Conclusion TACE is an effective treatment for HCC with tumor thrombus in the portal vein with an increase of survival rate, although it may aggravate the impairment of the liver function, even causing acute hepatic failure. Therefore, superselective embolization of tumor feeding arteries should be advocated.