腔内导管射频消融联合tace对原发性肝癌患者门静脉癌栓的疗效及安全性分析

Efficacy and Safety of Intracavitary Catheter Radiofrequency Ablation Combined with TACE In Portal Vein Tumor Thrombus in Patients with Primary Liver Cancer

目的了解腔内导管射频消融联合TACE对原发性肝癌患者门静脉癌栓的疗效及其安全性。方法收集2016年1月至2018年10月本院经治原发性肝癌合并门静脉癌栓患者60例。依据抽签法分为观察组(30例)与对照组(30例)。对照组:给予TACE治疗。观察组给予TACE+腔内导管射频消融治疗。监测术前及术后4周AFP、门静脉再通情况、癌栓尺寸及穿刺口出血等手术相关不良事件的发生情况等。对所有数据进行对比分析。结果两组术前血清AFP水平差异无统计学意义(P>0.05)。两组术后血清AFP水平均较术前降低,差异均有统计学意义(P均>0.05)。观察组术后血清AFP水平低于对照组,差异有统计学意义(P<0.05)。观察组门静脉再通率高于对照组,差异有统计学意义(P<0.05)。两组术前门静脉癌栓尺寸差异无统计学意义(P>0.05)。两组癌栓术后癌栓尺寸均较术前减小,差异有统计学意义(P均<0.05)。观察组术后癌栓尺寸小于对照组,差异有统计学意义(P<0.05)。观察组穿刺口出血及穿刺血管夹层发生率均低于对照组,差异有统计学意义(P均<0.05)。两组假性动脉瘤、胃肠道不适及栓塞后综合征发生率差异均无统计学意义(P均>0.05)。结论腔内导管射频消融联合TACE可有效治疗原发性肝癌门静脉癌栓实现门静脉再通,且并不会增加手术相关不良事件的发生。

Objective To learn the efficacy and safety of intracavitary catheter radiofrequency ablation combined with TACE in portal vein tumor thrombosis in patients with primary liver cancer.Methods Sixty patients with primary liver cancer and portal vein tumor thrombus,treated in our hospital from January 2016 to October 2018 were collected.According to the drawing method,patients was divided into observation group(30 cases)and control group(30 cases).TACE was given in control group.TACE+intracavitary catheter radiofrequency ablation were given in observation group.Serum AFP,portal recanalization,tumor thrombus size and Surgery-related adverse events(such as puncture bleeding)were monitored before and 4 weeks after surgery.Results There was no significant difference in serum AFP levels between the two groups(P>0.05).The serum AFP levels in the two groups were lower than those before surgery(P>0.05).The serum AFP level in the observation group was lower than that in the control group(P<0.05).The recanalization rate of portal vein in the observation group was higher than that in the control group(P<0.05).There was no significant difference in the size of preoperative portal vein tumor thrombus between the two groups(P>0.05).The size of tumor thrombus in both groups was lower than that before operation(P<0.05).The size of postoperative tumor thrombus in the observation group was smaller than that in the control group(P<0.05).The incidence of puncture bleeding and puncture vascular dissection in the observation group was lower than that in the control group(P<0.05).There was no significant difference in the incidence of pseudoaneurysm,gastrointestinal discomfort and post-embolic syndrome between the two groups(P>0.05).Conclusion Intracavitary catheter radiofrequency ablation combined with TACE can effectively treat portal vein recanalization in primary hepatic accompanied with portal vein tumor thrombus,and does not increase the incidence of surgical related adverse events.