超声引导下经皮消融治疗门静脉癌栓

Percutaneous ultrasound-guided ablation for portal vein tumor thrombus

目的 探讨超声引导下经皮消融门静脉癌栓（PVTT）的安全性、有效性及预后影响因素.方法 分析超声引导下经皮消融治疗50例患者54个PVTT的并发症、局部疗效及长期生存情况,分析可能影响生存率的因素.结果 50例均顺利完成PVTT消融治疗,发生严重并发症（针道移植）1例（2.0％）.局部消融有效率75.9％ （41/54）.消融治疗后1、12、24、36个月生存率分别为98.0％、49.7％、28.4％、11.8％.单因素分析显示肝功能Child-Pugh分级（P =0.011）、局部疗效（P=0.015）影响生存率.多因素Cox模型显示局部疗效（P =0.002）、肝功能分级（P =0.018）、年龄（P =0.028）、PVTT消融方法（P =0.049）是影响生存率的因素.结论 超声引导下经皮消融门静脉癌栓是一种较为安全、有效的方法.在经皮消融PVTT中,局部疗效、肝功能分级、年龄、PVTT消融方法是预后影响因素,妥当选择适应证和消融方法是必要的.

Objective To evaluate the efficacy and safety of ultrasound-guided ablation for portal vein tumor thrombus （PVTT） and to investigate the prognostic factors.Methods 50 patients with 54 PVTT underwent percutaneous ultrasound-guided ablation.The local treatment response,overall survival and complications were analysed.Results 50 （100%） patients successfully completed the ablation process.Major complication occurred in 1 patient （2%）.41 （75.9%） of 54 thrombi achieved efficacious local therapeutic response.The overall survival rates at 1,12,24 and 36 months were 98.0%,49.7%,28.4% and 11.8%,respectively.On univariate analysis,liver function grading （P =0.011） and local therapeutic efficacy （P =0.015） were significant predictors of overall survival.On multivariate analysis,local therapeutic efficacy （P =0.002）,liver function grading （P =0.018）,age （P =0.028） and treatment method of PVTT （P =0.049） were significant predictors of overall survival.Conclusions Percutaneous ultrasound-guided ablation is a safe and efficacious therapeutic technique for PVTT.Prognostic factors of overall survival for PVTT after ablation were regional treatment efficacy,hepatic function grading,age and treatment method of PVTT.It is important to choose a proper treatment method for ablation.