目的探讨128层螺旋CT在门静脉海绵样变性(cavernous transformation of portalvein,CTPV)向肝性侧支静脉诊断中的价值。方法选取我院经CT诊断为CTPV的患者40例,所有病例均行上腹部螺旋CT平扫及三期增强扫描,图像均采用最大密度投影、多...目的探讨128层螺旋CT在门静脉海绵样变性(cavernous transformation of portalvein,CTPV)向肝性侧支静脉诊断中的价值。方法选取我院经CT诊断为CTPV的患者40例,所有病例均行上腹部螺旋CT平扫及三期增强扫描,图像均采用最大密度投影、多平面重组、容积再现(VR)等后处理进行血管成像,以显示异常的门静脉及向肝性侧支静脉情况。结果40例CTPV患者中,37例能清楚地显示CTPV向肝侧支静脉起源部位、走行及与周围脏器的关系,从而判断侧支静脉来源,占92.5%。主要表现为以下3支向肝性侧支静脉:(1)胆囊周围侧支开放者28例,占75.6%;(2)胆总管周围侧支开放者16例,占43.2%;(3)胰十二指肠周围侧支开放者11例,占29.7%。另外3例只能显示门静脉周围蜂窝状侧支血管网,无法识别侧支静脉的起源及走形途径,占7.5%。结论 MSCT检查能优化CTPV侧支静脉的显示,能准确地识别向肝性侧支血管的起止和走行路线,提供直观的诊断依据,是诊断CTPV的重要检查方法。展开更多
Patients with hepatocellular carcinoma(HCC) accompanying portal vein tumor thrombosis(PVTT) have relatively few therapeutic options and an extremely poor prognosis. These patients are classified into barcelonaclinic l...Patients with hepatocellular carcinoma(HCC) accompanying portal vein tumor thrombosis(PVTT) have relatively few therapeutic options and an extremely poor prognosis. These patients are classified into barcelonaclinic liver cancer stage C and sorafenib is suggested as the standard therapy of care. However, overall survival(OS) gain from sorafenib is unsatisfactory and better treatment modalities are urgently required. Therefore, we critically appraised recent data for the various treatment strategies for patients with HCC accompanying PVTT. In suitable patients, even surgical resection can be considered a potentially curative strategy. Transarterial chemoembolization(TACE) can be performed effectively and safely in a carefully chosen population of patients with reserved liver function and sufficient collateral blood flow nearby the blocked portal vein. A recent metaanalysis demonstrated that TACE achieved a substantial improvement of OS in HCC patients accompanying PVTT compared with best supportive care. In addition, transarterial radioembolization(TARE) using yttrium-90 microspheres achieves quality-of-life advantages and is as effective as TACE. A large proportion of HCC patients accompanying PVTT are considered to be proper for TARE. Moreover, TACE or TARE achieved comparable outcomes to sorafenib in recent studies and it was also reported that the combination of radiotherapy with TACE achieved a survival gain compared to sorafenib in HCC patients accompanying PVTT. Surgical resectionbased multimodal treatments, transarterial approaches including TACE and TARE, and TACE-based appropriate combination strategies may improve OS of HCC patients accompanying PVTT.展开更多
AIM:To investigate the prognostic factors in patients with hepatocellular carcinoma(HCC) accompanied by microscopic portal vein invasion(PVI).METHODS:Of the 267 patients with HCC undergoing hepatic resection at Aso Ii...AIM:To investigate the prognostic factors in patients with hepatocellular carcinoma(HCC) accompanied by microscopic portal vein invasion(PVI).METHODS:Of the 267 patients with HCC undergoing hepatic resection at Aso Iizuka Hospital,71 had PVI.After excluding 16 patients with HCC that invaded the main trunk and the first and second branches of the portal vein,55 patients with microscopic PVI were enrolled.RESULTS:The patients with HCC accompanied by microscopic invasion were divided into two groups:solitary PVI(PVI-S:n = 44),and multiple PVIs(PVI-M:n = 11).The number of portal vein branches invaded by tumor thrombi was 5.4 ± 3.8(2-16) in patients with PVI-M.In cumulative survival,PVI-M was found to be a significantly poor prognostic factor(P = 0.0019);while PVI-M and non-anatomical resection were significantly poor prognostic factors in disease-free survival(P = 0.0213,and 0.0115,respectively).In patients with PVI-M,multiple intrahepatic recurrence was more common than in the patients with PVI-S(P = 0.0049).In patients with PVI-S,non-anatomical resection was a significantly poor prognostic factor in disease-free survival(P = 0.0370).Operative procedure was not a significant prognostic factor in patients with PVI-M.CONCLUSION:The presence of PVI-M was a poor prognostic factor in patients with HCC,accompanied by microscopic PVI.Anatomical resection is recommended in these patients with HCC.Patients with HCC and PVI-M may also be good candidates for adjuvant chemotherapy.展开更多
文摘目的探讨128层螺旋CT在门静脉海绵样变性(cavernous transformation of portalvein,CTPV)向肝性侧支静脉诊断中的价值。方法选取我院经CT诊断为CTPV的患者40例,所有病例均行上腹部螺旋CT平扫及三期增强扫描,图像均采用最大密度投影、多平面重组、容积再现(VR)等后处理进行血管成像,以显示异常的门静脉及向肝性侧支静脉情况。结果40例CTPV患者中,37例能清楚地显示CTPV向肝侧支静脉起源部位、走行及与周围脏器的关系,从而判断侧支静脉来源,占92.5%。主要表现为以下3支向肝性侧支静脉:(1)胆囊周围侧支开放者28例,占75.6%;(2)胆总管周围侧支开放者16例,占43.2%;(3)胰十二指肠周围侧支开放者11例,占29.7%。另外3例只能显示门静脉周围蜂窝状侧支血管网,无法识别侧支静脉的起源及走形途径,占7.5%。结论 MSCT检查能优化CTPV侧支静脉的显示,能准确地识别向肝性侧支血管的起止和走行路线,提供直观的诊断依据,是诊断CTPV的重要检查方法。
文摘Patients with hepatocellular carcinoma(HCC) accompanying portal vein tumor thrombosis(PVTT) have relatively few therapeutic options and an extremely poor prognosis. These patients are classified into barcelonaclinic liver cancer stage C and sorafenib is suggested as the standard therapy of care. However, overall survival(OS) gain from sorafenib is unsatisfactory and better treatment modalities are urgently required. Therefore, we critically appraised recent data for the various treatment strategies for patients with HCC accompanying PVTT. In suitable patients, even surgical resection can be considered a potentially curative strategy. Transarterial chemoembolization(TACE) can be performed effectively and safely in a carefully chosen population of patients with reserved liver function and sufficient collateral blood flow nearby the blocked portal vein. A recent metaanalysis demonstrated that TACE achieved a substantial improvement of OS in HCC patients accompanying PVTT compared with best supportive care. In addition, transarterial radioembolization(TARE) using yttrium-90 microspheres achieves quality-of-life advantages and is as effective as TACE. A large proportion of HCC patients accompanying PVTT are considered to be proper for TARE. Moreover, TACE or TARE achieved comparable outcomes to sorafenib in recent studies and it was also reported that the combination of radiotherapy with TACE achieved a survival gain compared to sorafenib in HCC patients accompanying PVTT. Surgical resectionbased multimodal treatments, transarterial approaches including TACE and TARE, and TACE-based appropriate combination strategies may improve OS of HCC patients accompanying PVTT.
文摘AIM:To investigate the prognostic factors in patients with hepatocellular carcinoma(HCC) accompanied by microscopic portal vein invasion(PVI).METHODS:Of the 267 patients with HCC undergoing hepatic resection at Aso Iizuka Hospital,71 had PVI.After excluding 16 patients with HCC that invaded the main trunk and the first and second branches of the portal vein,55 patients with microscopic PVI were enrolled.RESULTS:The patients with HCC accompanied by microscopic invasion were divided into two groups:solitary PVI(PVI-S:n = 44),and multiple PVIs(PVI-M:n = 11).The number of portal vein branches invaded by tumor thrombi was 5.4 ± 3.8(2-16) in patients with PVI-M.In cumulative survival,PVI-M was found to be a significantly poor prognostic factor(P = 0.0019);while PVI-M and non-anatomical resection were significantly poor prognostic factors in disease-free survival(P = 0.0213,and 0.0115,respectively).In patients with PVI-M,multiple intrahepatic recurrence was more common than in the patients with PVI-S(P = 0.0049).In patients with PVI-S,non-anatomical resection was a significantly poor prognostic factor in disease-free survival(P = 0.0370).Operative procedure was not a significant prognostic factor in patients with PVI-M.CONCLUSION:The presence of PVI-M was a poor prognostic factor in patients with HCC,accompanied by microscopic PVI.Anatomical resection is recommended in these patients with HCC.Patients with HCC and PVI-M may also be good candidates for adjuvant chemotherapy.
