经肝动脉化疗栓塞术、经门静脉化疗栓塞术联合高强度聚焦超声治疗门静脉癌栓的临床研究

Combination use of TACE,PVE and HIFU for the treatment of portal vein cancerous thrombus:a clinical study

目的观察经肝动脉化疗栓塞术(TACE)、经门静脉化疗栓塞术(PVE)联合高强度聚焦超声(HIFU)治疗原发性肝癌合并门静脉癌栓的临床疗效。方法分析2011年1月至2012年2月收治的原发性肝癌合并门静脉癌栓患者85例,TACE、PVE联合HIFU治疗47例为观察组,TACE、PVE治疗38例为对照组,TACE治疗后2周行PVE,PVE后10 d左右行HIFU治疗。结果观察组的近期有效率为89.4%(42/47),对照组为39.5%(15/38),两组比较差异有统计学意义(P<0.05)。观察组6个月、1年、2年的生存率为87.2%(41/47)、66.0%(31/47)、27.7%(13/47),中位生存期15.4个月,对照组上述时间点生存率分别为55.3%(21/38)、39.5%(15/38)和10.5%(4/38),中位生存期10.3个月,两组比较差异有统计学意义(P<0.05)。结论 TACE、PVE联合HIFU治疗原发性肝癌门静脉癌栓可显著提高疗效,延长生存时间,是一种较为安全、有效的治疗方法。

Objective To evaluate the combination use of transcatheter arterial chemoembolization（TACE）,portal vein embolization（PVE） and high intensity focused ultrasound（HIFU） in treating portal vein tumor thrombus（PVTT）.Methods A total of 85 patients with primary hepatocellular carcinoma complicated by PVTT,who were encountered during the period from Jan.2011 to Feb.2012 at authors＇ hospital,were enrolled in this study.The patients were divided into the study group（n = 47） and the control group（n = 38）.TACE,PVE and HIFU were performed in the patients of the study group,while only TACE and PVE were carried out in the patients of the control group.The therapeutic process was as follows：PVE was carried out 2 weeks after TACE was performed,and for the patients of the study group additional HIFU was conducted about 10 days after PVE procedure.Results The short-term effective rate in the study group and the control group was89.4%（42/47） and 39.5%（15/38） respectively,and the difference between the two groups was statistically significant（P〈0.05）.The 6-month,one-year,and two-year survival rate in the study group were 87.2%（41/47）,66.0%（31/47） and 27.7%（13/47） respectively; the median survival time was 15.4 months.In the control group,the 6-month,one-year,and two-year survival rate were 55.3%（21/38）,39.5%（15/38） and10.5%（4/38） respectively; the median survival time was 10.3 months.The differences between the two groups were statistically significant（P〈0.05）.Conclusion For the treatment of primary hepatocellular carcinoma associated with portal vein tumor thrombus,transcatheter arterial chemoembolization,portal vein embolization together with high intensity focused ultrasound is an safe and effective therapy as it can significantly improve the therapeutic effect and prolong the survival time.