肝细胞癌伴门静脉癌栓的介入综合治疗

Comprehensive interventional treatment of hepatocellular carcinoma with portal vein tumor thrombosis

伴门静脉癌栓(PVTT)的肝细胞癌(HCC)常见于进展期肝癌,PVTT可引起肿瘤播散、肝功能衰竭和门静脉高压,从而导致顽固性腹水、静脉曲张破裂和肝性脑病,严重影响肝癌患者预后。根据巴塞罗那临床肝癌分期(BCLC),伴PVTT的进展期HCC,索拉非尼被推荐为一线治疗方案,但由于其疗效有限且价格昂贵限制了它在国内的应用。而介入治疗以其微创、可重复性等优点在临床得到广泛应用,并取得一定的疗效。目前主要应用的介入治疗方法包括:经肝动脉灌注化疗术(HAIC)、经肝动脉化疗栓塞术(TACE)、TACE联合索拉非尼、TACE联合消融术、TACE联合适形放疗、TACE联合门静脉支架、门静脉粒子条置放术、经颈静脉肝内门体分流术(TIPS)等。最后指出多种方法综合治疗有望取得较好疗效。

Portal vein tumor thrombosis（ PVTT） often occurs in advanced hepatocellular carcinoma（ HCC） patients. PVTT may cause tumor dissemination,liver failure,and portal hypertension,thus leading to intractable ascites,variceal rupture,and hepatic encephalopathy,which will result in a poor prognosis. According to the Barcelona Clinic Liver Cancer Staging System,sorafenib is recommended as the first- line treatment for advanced HCC with PVTT,but its application in China has been limited due to its mild efficacy and high price.Nowadays,interventional treatment is widely used in the treatment of advanced HCC with PVTT due to the advantages of minimal invasiveness and repeatability and shows good efficacy. At present,the main methods of interventional treatment include hepatic arterial infusion chemotherapy,transcatheter arterial chemoembolization（ TACE）,TACE combined with sorafenib,TACE combined with ablation,TACE combined with three- dimensional conformal radiotherapy,TACE combined with portal vein stent placement,endovascular implantation of iodine- 125 seeds strand,and transjugular intrahepatic portosystemic shunt. It is pointed out that multimodality treatment is expected to achieve good efficacy in the treatment of advanced HCC with PVTT.