CAJ | 학술논문

目的探讨门静脉支架联合125I粒子链植入序贯肝动脉灌注化学疗法栓塞术(TACE)治疗肝癌伴门静脉癌栓的临床价值.方法回顾性分析26例肝癌伴门静脉癌栓患者的临床资料.所有患者均先行经皮肝穿刺门静脉支架联合125I粒子链植入术,然后再行TACE治疗.随访并计算累积生存率.结果 26例患者中,男25例,女1例,中位年龄为49岁.肝内单发病灶10例,其中右肝癌8例,左肝癌2例,多发病灶16例.门静脉右支癌栓6例,门静脉左支癌栓3例,门静脉主干和右支癌栓13例,门静脉主干和左支癌栓4例.Child-Pugh A级20例,Child-Pugh B级6例.所有患者顺利完成门静脉支架联合12 sI粒子链序贯TACE治疗,手术成功率为100％.共植入支架26枚、125I粒子链28条(共520粒12sI粒子),TACE治疗共55次.所有患者均未出现穿刺道出血、胆汁漏并发感染、肝脓肿、腹腔出血、肿瘤破裂出血及消化道出血等严重并发症.术后随访6～15个月.术后3、6、9、12及15个月的累积生存率为100.0％(26/26)、61.5％(16/26)、53.8％(14/26)、30.8％(8/26)、15.4％(4/26);支架累积通畅率为96.2％(25/26)、76.9％ (20/26)、57.7％(15/26)、23.1％(7/26)、7.7％ (2/26).16例死亡患者中,2例死于肺转移,5例死于消化道出血,6例死于肝功能衰竭,1例死于脑转移,1例死于椎体转移,1例肿瘤侵及心房导致心功能衰竭死亡.结论门静脉支架联合125I粒子链植入联合TACE治疗肝癌伴门静脉癌栓患者,可获较长支架通畅时间和生存期.
목적 탐토문정맥지가연합125I입자련식입서관간동맥관주화학요법전새술(TACE)치료간암반문정맥암전적림상개치.방법 회고성분석26례간암반문정맥암전환자적림상자료.소유환자균선행경피간천자문정맥지가연합125I입자련식입술,연후재행TACE치료.수방병계산루적생존솔.결과 26례환자중,남25례,녀1례,중위년령위49세.간내단발병조10례,기중우간암8례,좌간암2례,다발병조16례.문정맥우지암전6례,문정맥좌지암전3례,문정맥주간화우지암전13례,문정맥주간화좌지암전4례.Child-Pugh A급20례,Child-Pugh B급6례.소유환자순리완성문정맥지가연합12 sI입자련서관TACE치료,수술성공솔위100％.공식입지가26매、125I입자련28조(공520립12sI입자),TACE치료공55차.소유환자균미출현천자도출혈、담즙루병발감염、간농종、복강출혈、종류파렬출혈급소화도출혈등엄중병발증.술후수방6～15개월.술후3、6、9、12급15개월적루적생존솔위100.0％(26/26)、61.5％(16/26)、53.8％(14/26)、30.8％(8/26)、15.4％(4/26);지가루적통창솔위96.2％(25/26)、76.9％ (20/26)、57.7％(15/26)、23.1％(7/26)、7.7％ (2/26).16례사망환자중,2례사우폐전이,5례사우소화도출혈,6례사우간공능쇠갈,1례사우뇌전이,1례사우추체전이,1례종류침급심방도치심공능쇠갈사망.결론 문정맥지가연합125I입자련식입연합TACE치료간암반문정맥암전환자,가획교장지가통창시간화생존기.
Objective To assess the clinical value of portal vein stenting (PVS) combined 125I particle implanted followed by transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT).Methods The clinical data of 26 patients with HCC accompanied with MPVTT were retrospectively analyzed.All the patients received PVS combined 125I particle implanted first and TACE treatment later.The patients were followed-up and the cumulative survival rate was calculated.Results There were 25 male,one female and the median age was 49 years.Sixteen cases had multiple lesions in the liver and 10 cases had single lesion.Among those,the lesion of eight cases was in right lobe and two in left lobe.A total of six patients with right portal vein tumor thrombus,three with left portal vein tumor thrombus,13 with main and right portal vein tumor thrombus and four with main and left portal vein tumor tbrombus.The liver function grading of 20 patients was Child-Pugh A and six was Child-Pugh B.All the patients received PVS combined 125I particle implanted followed by TACE treatment successfully,the success rate of operation was 100％.A total of 26 stents and 28 125I particle chains (520 125I particles) were implanted and 55 TACE were operated.In all the patients,no severe complications,such as puncture bleeding,bile leak complicated by infection,liver abscess,abdominal bleeding,tumor rupture bleeding and gastrointestinal bleeding occurred.After operation,patients were followed-up for 6 to 15 months.The survival rates at 3th,6th,9th,12thand 15thmonth were 100.0％ (26/26),61.5％ (16/26),53.8％ (14/26),30.8％ (8/26) and 15.4％ (4/26),respectively.The stent patency rates were 96.2％ (25/26),76.9％ (20/26),57.7％ (15/26),23.1％ (7/26) and 7.7％ (2/26),respectively.Among 16 dead patients,two died of lung metastasis,five died of gastrointestinal bleeding,six died of liver failure,and one died of brain metastases,one died of vertebral metastases,one died of heart failure for tumor invasion in atrial.Conclusion Treated by PVS combined 125I particle implanted followed by TACE,HCC patients with MPVTT complication may obtain a long stent patency and survival time.