原发性肝癌并门静脉癌栓的“双介入性”治疗

Dual Intervention" Therapy for the Primary Hepatic Carcinoma Accompanied with Portal Cancerous Thrombus

目的 评价“双介入性”灌注及栓塞治疗原发性肝癌并门静脉癌栓的临床应用价值,探讨有效的治疗方案和方法。资料与方法 对47例肝内单个或2个以上病灶并均有门静脉癌栓者,行直接肝动脉和间接门静脉血管造影,明确肿瘤、门静脉癌栓及血供情况。视门静脉癌栓的程度制定出介入化疗栓塞方案。采用三联用药、超液化碘油及酌情加用明胶海绵颗粒,对肝内肿瘤和门静脉癌栓进行直接或间接介入栓塞治疗。其介入治疗后6～36个月患者的总生存率分别与单纯化疗药物灌注组和无门静脉癌栓组患者的总生存率进行比较和统计学处理分析。结果 经介入治疗后,实验组患者6、12、24、36个月的总生存率(98.9％、84.3％、46.7％、4.2％)显著高于单纯化疗药物灌注组(P<0.001);与无门静脉癌栓组患者的总生存率相近(P>0.05)。结论 原发性肝癌并门静脉癌栓并非栓塞的禁忌症。采用“双介入性”的化疗及栓塞为行之有效的介入治疗方法,取得与无门静脉癌栓的原发性肝癌的介入治疗相近、个别甚或超过的效果,具有重要的临床治疗价值。

Objective To evaluate 'dual intervention' therapy in treating primary hepatic carcinoma accompanied with portal cancerous thrombus, to discuss the technical points of the therapy. Materials and Methods Forty-seven patients with single or multiple hepatic lesions as well as portal cancerous thrombus (study group) were enrolled into this study. Using Seldinger's technique, direct hepatic arteriography and indirect portal venography were performed. The location, number, size, feeding artery of the tumor and the portal cancerous thrombus were identified. The chemoembolization therapy plan was made according to the extent of portal involvement. Triple anti-cancerous drugs, ultraliquefied iodized oil and, in some cases, Gelfoam particles were used. Direct or indirect interventional embolization was performed for both the hepatic lesion and portal cancerous thrombus. The total survival rate at 6, 12, 24 and 36 months after the procedure was compared with that of control groups (pure chemical infusion group and group not accompanying portal thrombus) , and statistic analysis was made. Results The total survival rate of the study group at 6, 12, 24 and 36 months after treatment was 98.9% , 84.3% , 46.7% and 4.2% , respectively, which was significantly higher than that of pure chemical infusion group (P < 0.001) , but was similar to that of group not accompanying portal thrombus ( P > 0.05). Conclusion Embolization is not a contraindication for primary hepatic carcinoma accompanied with portal cancerous thrombus. ' Dual intervention' therapy, that is to treat both the hepatic lesion and portal cancerous thrombus with chemical infusion and embolization simultaneously, is an effective treatment for such patients.