TIPS联合125I粒子植入治疗肝癌门脉主干癌栓及合并症的效果

Clinical efficacy of TIPSS combined with 125I seeds implantation for HCC associated with main portal vein tumor thrombus and complications

目的分析TIPS联合125I粒子植入术治疗肝癌门静脉主干癌栓的临床疗效。方法收集2011年1月至2016年3月收治的肝癌门静脉主干癌栓合并门静脉高压的患者102例,分为TIPS联合125I放射粒子植入术(研究组)57例,单纯应用TIPS(对照组)45例。比较两组在分流前后的门静脉压力,治疗效果(标准缓解率、总有效率),预后情况(累积生存率、中位生存期、分流道累积再狭窄率、症状复发率)等。结果①术中两组在分流后的门静脉压力均低于分流前,差异有统计学意义(P<0.001);②研究组的标准缓解率高于对照组(96.5%比26.7%),总有效率亦高于对照组(100%比35.6%),差异均有统计学意义(χ2=65.045、51.326,P<0.001);③术后6个月,研究组的分流道累积再狭窄率为8.8%(5/57),低于对照组的24.4%(11/45);症状复发率为10.5%(6/57),亦低于对照组的26.7%(12/45),差异均有统计学意义(P<0.01);④研究组的中位生存期为11.8个月,高于对照组的7.3个月,差异有统计学意义。结论TIPS联合125I粒子植入术治疗肝癌门静脉主干癌栓及其合并症效果好、安全性高,在很大程度上延长了患者生存期。

Objective To discuss the clinical efficacy of transjugular intrahepatic portosystemic stentshunt(TIPSS)combined with 125I seeds implantation for hepatocellular carcinoma(HCC)associated with main portal vein tumor thrombus.Methods The clinical data of 102 patients with HCC complicated by main portal vein tumor thrombus and portal hypertension,who were admitted to authors’hospital during the period from January 2011 to March 2016,were collected.The patients were divided into study group(n=57,treated with TIPSS combined with 125I seeds implantation)and control group(n=45,treated with TIPSS only).The preoperative and postoperative portal venous pressure(PVP),curative effect(standard remission rate and overall response rate)and the prognosis(cumulative survival rate,median survival time,cumulative re-stenosis rate of shunt,recurrence rate of symptoms)were compared between the two groups.Results(1)During the performance of TIPSS,after the shunt was established the PVP value became lower than preoperative one in both groups,the difference was statistically significant(P<0.001).(2)The standard remission rate and overall response rate of the study group was 96.49%and 100%respectively,which were remarkably higher than 26.67%and 35.56%respectively of the control group,the differences were statistically significant(χ2=65.045 andχ2=51.326 respectively,P<0.001).(3)Six months after treatment,the cumulative re-stenosis rate of shunt in the study group was 8.8%(5/57),which was lower than 24.4%(11/45)in the control group.The recurrence rate of symptoms in the study group was 10.5%(6/57),which was also lower than 26.7%(12/45)in the control group.The differences were statistically significant(P<0.001).(4)The median survival time in the study group was 11.8 months,which was higher than 7.3 months in the control group.The difference was statistically significant.Conclusion For the treatment of HCC associated with main portal vein tumor thrombus and complications,TIPSS combined with 125I seeds implantation has satisfactory curative effect with high safety,it can prolong patient’s survival time to a large extent.