肝细胞肝癌门静脉癌栓介入分型及其临床应用价值

Classification of interventional radiology for portal vein tumor thrombus of hepatocellular carcinoma and its clinical application value

目的:探讨适合指导介入治疗的肝细胞肝癌门静脉癌栓介入分型。方法:根据肝细胞肝癌合并门静脉癌栓患者的动态增强CT或MR影像学表现,将门静脉癌栓分为Ⅰ~Ⅴ共5型,包括Ⅰ型、Ⅱa型/Ⅱb型、Ⅲa型/Ⅲb型/Ⅲc型、Ⅳa型/Ⅳb型、Ⅴ型,其中将Ⅰ~Ⅳ型同时合并肝动脉门静脉瘘归为Ⅴ型。观察不同分型患者经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合门静脉支架+放射性碘-125粒子条植入治疗的效果。结果:117例入选患者介入分型为Ⅰ型占10.2%(12/117)、Ⅱ型占17.1%(20/117)、Ⅲ型占53%(62/117)、Ⅳ型占19.6%(23/117)、Ⅴ型占16.2%(19/117)。所有患者均接受介入治疗,术后即刻造影显示,68例(93.1%)患者门静脉灌注明显改善。术后1~3个月增强MR/CT随访显示,植入碘-125粒子部位的癌栓均较术前明显萎缩,有效控制。结论:肝细胞肝癌合并门静脉癌栓的介入分型有助于指导临床制定个体化的介入治疗策略,使患者获益,值得临床推广。

Objective:To explore the classification of portal vein tumor thrombus of hepatocellular carcinoma(HCC)for interventional treatment.Methods:The dynamic enhanced CT or MR imaging features of patients with portal vein tumor thrombus of HCC were analyzed.The portal vein tumor thrombus was divided into 5 types(Ⅰ-Ⅴ)for interventional treatment,including 2 subtypes of typeⅡ,3 subtypes of typeⅢ,and 2 subtypes of typeⅣ.The patients of typeⅠ-Ⅳcombined with hepatic arterioportal fistula were classified into typeⅤ.Then the effect of transcatheter arterial chemoembolization(TACE)combined with portal vein tumor thrombus and radioactive iodine-125 seeds strip implantation was observed.Results:All cases were classified successfully,including 10.2%typeⅠ,17.1%typeⅡ,53%typeⅢ,19.6%typeⅣ,and 16.2%typeⅤwith hepatic arterioportal fistula.The portal vein perfusion was improved in 68 cases(93.1%).The follow-up of 1-3 months after operation showed that the tumor thrombus at the site of implantation of iodine-125 particles was significantly atrophic with effective thrombus control.Conclusions:The classification of interventional therapy for HCC complicated with portal vein tumor thrombus is helpful to guide the clinical formulation of individualized interventional therapy strategy,which is worthy of promotion.