CAJ | 학술논문

目的回顾性分析肝细胞肝癌伴门静脉主干癌栓(MPWIT)患者经门静脉支架置入及经导管化疗栓塞治疗后序贯门静脉适形放疗的效果.方法 45例肝癌合并MPVTY的患者行经皮门静脉支架置入,支架置入后即刻行经导管动脉内化疗栓塞.其中16例于2～3周后行门静脉适形放疗(A组),29例未行放射治疗(B组).采用Kaplan-Meier生存分析、log-rank检验评价两组间支架通畅率、累积生存率的差异;Fisher精确概率法对比分析两组间肿瘤及癌栓缓解率的差别.结果本组支架放置过程中及置入后24 h内无患者死亡,无大出血及急性肝功能衰竭等严重并发症.支架置入后2周内所有支架通畅,术后60、180、360 d支架累积通畅率:A组分别为100.0%.62.2%、34.6%,B组分别为58.6%、21.7%、10.8%;累积生存率:A组分别为93.8%、81.3%、32.5%,B组分别为86.2%、13.8%、6.9%,两组相比差异均有统计学意义(X2值分别为9.672、14.596,P值均<0.01).支架平均通畅时间A组为(475±137)d,B组为(200±61)d,两组相比差异有统计学意义(X2=9.672,P<0.01).结论经导管化疗栓塞联合门静脉支架置人后序贯门静脉适形放疗可提高肝细胞肝癌伴MPVTT患者支架通畅率和生存期.
목적 회고성분석간세포간암반문정맥주간암전(MPWIT)환자경문정맥지가치입급경도관화료전새치료후서관문정맥괄형방료적효과.방법 45례간암합병MPVTY적환자행경피문정맥지가치입,지가치입후즉각행경도관동맥내화료전새.기중16례우2～3주후행문정맥괄형방료(A조),29례미행방사치료(B조).채용Kaplan-Meier생존분석、log-rank검험평개량조간지가통창솔、루적생존솔적차이;Fisher정학개솔법대비분석량조간종류급암전완해솔적차별.결과 본조지가방치과정중급치입후24 h내무환자사망,무대출혈급급성간공능쇠갈등엄중병발증.지가치입후2주내소유지가통창,술후60、180、360 d지가루적통창솔:A조분별위100.0%.62.2%、34.6%,B조분별위58.6%、21.7%、10.8%;루적생존솔:A조분별위93.8%、81.3%、32.5%,B조분별위86.2%、13.8%、6.9%,량조상비차이균유통계학의의(X2치분별위9.672、14.596,P치균<0.01).지가평균통창시간A조위(475±137)d,B조위(200±61)d,량조상비차이유통계학의의(X2=9.672,P<0.01).결론 경도관화료전새연합문정맥지가치인후서관문정맥괄형방료가제고간세포간암반MPVTT환자지가통창솔화생존기.
Objective To retrospectively analyze the role of 3-dimensioual conformal radiotherapy (3-DCRT) after percutaneous transhepatic portal vein stenting and transcatheter arterial chemoembolization (PTPVS-TACE) in the treatment of patients with hepatocellular carcinoma (HCC) complicated by main portal vein tumor throw.bus (MPVTT).Methods Between July 2002 and July 2007,45 patients with HCC complicated by MPVTT were treated by PTPVS-TACE.Among them,3-DCRT were undertaken for MPVTT in 16 patients (group A),the other 29 patients were not treated with 3-DCRT(group B).The clinical effects,complication,stent patency rates,cumulative survival rates were evaluated among groups.The Kaplan-Meier method and log-rank test were used for survival analysis.Results No patient died during stent placement or within the preceding first 24 hours.No severe procedure-related complications were observed.The 60--,180--,360--day cumulative stent patency rates were 100.0%,62.2% and 34.6% in group A,and 58.6%,21.7% and 10.8% in group B,respectively,showing significant difference between the two groups (X2 =9.672,P <0.01).The mean patency time was(475±137) and (200±61)days,respectively.The 60--,180--,and 360--day cumulative survival rates were 93.8%,81.3% and 32.5% for group A,86.2%,13.8% and 6.9% for group B,respectively.There were significant statistical differences between the two groups(X2=9.672,14.596,P < 0.01).Conclusion Treatment with PTPVS-TACE-3-DCRT is a more effective modality than PTPVS-TACE for HCC complicated by MPVTT.