125I粒子条联合门静脉支架及TACE序贯索拉非尼治疗肝癌合并门静脉主干癌栓

Endovascular implantation of iodine-125 seeds strand and portal vein stenting followed by transcatheter arterial ehemoembolization combined therapy with sorafenib for hepatoeellular carcinoma with main portal vein tumor thrombus

目的比较125I粒子条联合门静脉支架及经导管肝动脉化疗栓塞（TACE）序贯或未序贯索拉非尼治疗肝癌合并门静脉主干癌栓的疗效。方法回顾分析2010年1月至2015年8月于江苏省盐城市第三人民医院接受TACE治疗的53例原发性肝癌合并门静脉主干癌栓的临床资料，其中男45例、女8例，平均年龄50．55岁，按照治疗方式的不同分为两组，其中38例（A组）在门静脉主干内植入支架及125I后仅行TACE治疗，余15例（B组）在门静脉主干内植入支架及125I后行TACE治疗基础上联合索拉非尼。分别对两组患者进行累积生存期、无进展生存期及相关不良事件进行分析。结果门脉内植入支架125I粒子条介入技术成功率100％，无严重手术并发症及相关不良事件的发生。A组和B组患者的中位生存期分别为12．1及14．8个月（P=0．037）；A组和B组患者的中位无进展生存期分别为2．8及4．0个月（P=0．002）。结论门静脉支架及TACE联合125I粒子条序贯服用索拉非尼能显著延长原发性肝癌伴门静脉主干癌栓患者的生存期。

Objective To compare the therapeutic effect of portal vein stenting and endovascular implantation of iodine-125 seeds strand followed by transcatheter arterial ehemoembolization combined with or without sorafenib in patients for hepatoeellular carcinoma （HCC） with main portal vein tumor thrombus （MPVTF）. Methods A total of 53 patients with HCC complicated by MPVTF who received portal vein stenting and endovascular implantation of iodine-125 seeds strand followed by transcatheter arterial ehemoembolization combined without （group A, n = 38） or with （group B, n = 15 ） sorafenib in Affiliated Yancheng Hospital of Southeast University Medical College during January 2010 and August 2015 were analyzed retropectively. Overal survival, progress free survival and procedure-related adverse event were compared between the two groups. Results The technical success rate was 100% for placement of ~25I seeds strand and stent in the obstructed main portal vein. No serious procedure-related adverse events occurred. Median survival time of group A and B were 12. 1 and 14.8 months, respectively （P=0.037）. Additionally, Median progress free survival time of group A and B were 2. 8 and 4. 0 months, respectively （ P = 0. 002）. Conclusions Endovascular implantation of iodine-125 seeds strand and portal vein stenting followed by transcatheter arterial chemoembolization combined with sorafenib could improve the survival time, the progress free survival time of patients with HCC complicated by MPVTT.