支架联合^(125)I粒子条植入治疗肝癌所致下腔静脉恶性梗阻20例

Stenting combined with ^(125)I seed strand implantation for the treatment of inferior vena cavamalignant obstruction caused by hepatocellular carcinoma

目的评估支架联合^(125)I粒子条植入治疗下腔静脉(IVC)恶性梗阻的临床疗效。方法选取20例IVC恶性梗阻患者,行IVC支架联合^(125)I粒子条植入,术前术后分别对IVC梗阻长度、内径,右心房与梗阻段远端压差及患者临床梗阻症状积分进行统计分析。术后每2个月采用CT、彩色多普勒超声或者IVC造影对患者IVC通畅情况进行随访。结果 20例患者共植入26枚支架及40根粒子条,手术均一次性获得成功,未发生与手术相关严重并发症。IVC梗阻长度为(6.82±2.21)cm,狭窄段内径由(0.50±0.27)cm扩张至(1.55±0.33)cm。右心房与梗阻远端压差由术前(16.28±1.26)mm Hg降至术后(5.90±1.86)mm Hg,患者临床梗阻症状积分由术前4~5分(中位值4分)下降至术后0~2分(中位值0分)。随访2~26个月,支架通畅率为90%。结论支架联合^(125)I粒子条植入治疗下腔静脉恶性梗阻安全有效,为临床提供了一种新的姑息性治疗手段。

Objective To evaluate the clinical efficacy of endovascular deployment of stent combined with radioactive 125I seed strand implantation for the treatment of inferior vena cava （IVC）malignant obstruction caused by hepatocellular carcinoma. Methods Twenty patients with IVC malignant obstruction due to hepatocellular carcinoma were selected and were treated with IVC stenting together with 125I seed strand implantation. Before and after the treatment, the obstructed length and inner diameter of IVC, the pressure difference between the right atrium and the distal end of the obstructed segment, and patient＇s clinical symptom score were measured and the results were statistically analyzed. After the treatment, follow-up examinations with CT, color Doppler ultrasound or IVC venography were performed once every two months to check the patency of IVC. Results A total of 26 stents and 40 125I seed strands were used in 20 patients. Successful treatment with single operation was obtained in all patients, and no procedure-related severe complications occurred. The obstructed length of IVC was （6.82± 2.21 ） cm; the inner diameter of obstructed segment increased from preoperative （0.50±0.27）cm to postoperative （1.55 ±0.33 ）cm. The pressure difference between the right atrium and the distal end of the obstructed segment was reduced from preoperative （16.28±1.26）mmHg to postoperative （5.90± 1.86）mmHg. The patient＇s clinical symptom scores were decreased from preoperative 4-5 points （median of 4 points） to postoperative 0-2 points （median of 0 point）. All the patients were followed up for 2-26 months, the patency rate of IVC stents was 90%. Conclusion For the treatment of IVC malignant obstruction caused by hepatocellular carcinoma, endovascular deployment of stent combined with radioactive 125I seed strand implantation is safe and effective. This technique provides a new palliative treatment.