支架置入联合肝动脉化疗栓塞术对原发性肝癌伴门静脉或下腔静脉癌栓的临床疗效

Clinical efficacy of stent implantation combined with trans-arterial chemoembolization for primary hepatic carcinoma with portal vein and inferior vena cava tumor thrombus

目的评价支架置入联合肝动脉化疗栓塞术（TACE）在原发性肝癌伴门静脉、下腔静脉癌栓患者应用的临床价值。方法回顾性分析16例原发性肝癌伴门静脉、下腔静脉癌栓患者行支架置入治疗联合TACE治疗的临床资料,评价联合治疗的疗效和安全性。结果 16例成功置入支架,术中造影显示门静脉、下腔静脉血流通畅。4例阴囊水肿及8例腹壁静脉曲张患者支架置入术后表现全部消失;12例中度以上腹水患者术后7例腹水减轻;14例下肢水肿患者8例术后消失。生存时间为1-24个月,中位时间为3.7个月。1、3、6、12个月累积生存率分别为93.8%、56.3%、43.8%和25.0%。治疗前、后胆碱酯酶为（1 957.27±552.54）U/L和（1 652.85±231.39）U/L,凝血酶原时间为（16.38±2.28）s和（18.81±3.15）s,凝血酶原活动度为（55.83±10.67）%和（45.36±14.29）%,治疗前后比较,差异有统计学意义（P均〈0.05）。术后无严重不良并发症发生。结论对原发性肝癌合并门静脉、下腔静脉癌栓患者,采用支架置入联合TACE治疗可取得一定疗效。

Objective To evaluate the clinical value of stent implantation combined with trans-arterial chemoem-bolization（TACE） therapy for primary hepatic carcinoma（PHC） with portal vein and inferior vena cava tumor thrombus.Methods The clinical data of 16 PHC patients with portal vein or inferior vena cava tumor thrombus who undertook stent implantation combined with TACE were analyzed retrospectively. Results Stents were implanted successfully in 16 cases,angiography in operation showed that portal vein and inferior vene cava was unobstructed. The clinical manifestations dis-appeared after the treatment in 4 cases of scrotal edema and 8 cases of abdominal varicose veins; among 12 cases with moderate ascites, the clinical manifestations alleviated after the treatment in 7 cases; among 14 cases with lower ex-tremity edema, the clinical manifestations reduced after the treatment in 8 cases. The median survival time was 3.7（1-24） months. The cumulative survival rate in 1,3,6,12 months was 93.8%, 56.3%, 43.8% and 25.0% respectively. CHE of pre-operation and post-operation was（1 957.27 ± 552.54）U/L and（1 652.85 ±231.39）U/L respectively, PT was（16.38±2.28）s and（18.81± 3.15）s, PTA was（55.83 ± 10.67）% and（45.36± 14.29）% respectively.There were significant differences between pre-operation and post-operation（P〈0.05）. There were no serious adverse complications after treatment. Conclusion For PHC patients with portal vein and inferior vena cava tumor thrombus, whose liver function is Child-Pugh A and B before treatment, stent implantation combined with TACE can obtain some curative effect.