经皮穿脾食管胃底静脉曲张栓塞术治疗食管胃底静脉曲张

自 1974年瑞典人Ｌｕｎｄｅｒｑｕｉｓｔ和Ｖａｎｇ首先介绍了经皮穿肝胃食管曲张静脉栓塞术 ( ｐｅｒｃｕｔａｎｅｏｕｓｔｒａｎｓｈｅｐａｔｉｃｖａｒｉｃｅａｌｅｍｂｏｌｉｚａｔｉｏｎ ,ＰＴＶＥ)后 ,许多学者对其进行了广泛研究 ,证实ＰＴＶＥ在控制急性出血、降低病死率等方面有明显疗效。但其存在着门静脉主干必须保持通畅的缺陷[1] ,因此对于原发性肝癌合并门静脉癌栓闭塞病人 ,建立另一门静脉插管通道栓塞曲张静脉显得格外重要。 1999年 8月至 2 0 0 0年 1月 ,我们对 12例上述病人采用经皮穿脾胃底食管曲张静脉栓塞术 ( ｐｅｒ…     

门静脉支架联合动脉化学栓塞疗法治疗肝癌合并门静脉主干癌栓

肝癌(HCC)伴有门静脉主干癌栓(MPVTT)预后极差.由被阻塞门静脉供血的正常肝组织缺血,从而损害肝功能并限制了经肝动脉化疗栓塞(TACE)在治疗HCC中的应用.经皮穿刺肝脏门静脉支架植入(PTPVS)可姑息性解除门静脉阻塞.     

肝癌合并梗阻性黄疸的双介入治疗临床研究

目的探讨胆道支架置放结合动脉化疗栓塞治疗肝癌合并梗阻性黄疸的疗效。方法24例肝癌合并梗阻性黄疸患者行经皮穿肝胆道引流术后，采用置放胆道支架（总计31枚）结合动脉化疗栓塞（总计51次）的治疗方法。分别观察血清胆红素下降程度，手术并发症，并随访患者生存期和胆道支架维持通畅时间。结果24例患者PTCD成功率100％，治疗后总胆红素明显下降，由（201．8±154．7）μmol／L降至（120．8±106．7）μmol／L。引流通畅中位时间6．1个月，全组生存中位时间6．2个月。结论胆道支架置放结合动脉化疗栓塞治疗肝癌合并梗阻性黄疸有较好疗效。     

暂时闭塞肝静脉行肝动脉化疗栓塞治疗原发性肝癌时5-FU的血药浓度比较研究

目的研究暂时闭塞肝静脉行肝动脉化疗栓塞(TACE-THVO)治疗原发性肝癌时5-FU血浆药物浓度的变化,探讨肝TACE-THVO的适应证.方法20例原发性肝癌行TACE-THVO术.其中巨块型肝癌5例,结节型肝癌10例,弥漫型肝癌5例.肿瘤局限于肝右叶15例,跨叶或弥漫生长5例,肝动-静脉瘘5例.采用高效液相色谱法测定肝右静脉、肝静脉人下腔静脉口处、外周静脉5-FU血浆药物浓度.结果肝右静脉血浆5-FU平均血药浓度明显高于其它两个部位的血药浓度,且持续时间长.肿瘤局限于肝右叶者肝右静脉药物高浓度的平均持续时间为15 min,肿瘤跨叶或弥漫生长者为7min.肝癌不伴肝动-静脉瘘者平均持续时间为14min,有动-静脉瘘者为5min.结论肝TACE-THVO术能明显提高肿瘤局部5-FU的血药浓度,延长5-FU的作用时间,增强其抗肿瘤疗效.它的最佳适应症是局限于一叶的肝肿瘤.     

动脉化疗栓塞治疗恶性梗阻性黄疸

目的：探讨胆道支架置放后动脉化疗栓塞治疗恶性梗阻性黄疸(MOJ)的并发症和疗效，研究影响黄疸复发时间和患者生存期的预后因素。方法：51例MOJ患者放置胆道支架后接受动脉化疗栓塞术(TACE)，观察手术并发症，血清胆红素下降程度，随访黄疸复发时间和患者生存期。分析性别，年龄，肿瘤类型，术前血清胆红素浓度、碱性磷酸酶、谷丙转氨酶、白蛋白、血红蛋白浓度，梗阻时间，梗阻水平10个因素对黄疸复发时间和患者生存期的影响。结果：51例共计放置支架64枚，行TACE术86次，技术成功率为100％。1例于术后1个月死亡，在治疗过程中，4例出现肝脓肿。4例失访，51例生存期为1～34个月，平均9．0个月，中位值8．0个月。22例黄疸复发，复发率43．2％，黄疸复发时间2～14个月，平均11．0个月，中位值9．0个月。单因素(P=0．010)和多因素(P=0．010)分析均显示术前血清总胆红素浓度是影响患者生存期的重要因素。单因素分析显示对黄疸复发有显著影响的因素为肿瘤类型(P=0．035)。结论：MOJ患者放置胆道支架后进行TACE术，可以延缓黄疸复发，延长患者生存期。术前血清总胆红素浓度高的患者生存期较短；肝细胞肝癌患者的黄疸复发时间较非肝细胞肿瘤患者明显延长，黄疸复发率亦低于后者。     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.     

金属内支架置入联合三维适形放射治疗肝癌合并门静脉癌栓

Objective To study the clinical efficiency of metallic stent implantation in combination with three-dimensional conformal radiation therapy in the treatment of hepatocellular carcinoma (HCC) pa-tients with portal vein tumor thrombus. Methods 22 cases of HCC patients with portal vein tumor thrombus were devided into 2 groups: 10 patients (group A) recieved stent implantation in combination with conformal radiation therapy, 12 patients (group B) recieved stent implantation and transcatheter arterial chemoembolization. The adverse reactions, and liver function before and after treatment were compared between the two groups. The stent patency rate at 4, 6 and 12 months and the survival rate at 3, 6 and 12 months were followed up. Comparison of liver function was analyzed by Wilcoxon signed rank test. Compari-son of stent patency rate curves and survival curves was analyzed by Log rank test. Results The portal vein catheterization was successful in all the patients. The stents were successfully implanted by transhepatic portal vein approach, and portal vein stenosis was re-opened. There was no abdominal hemorrhage in all the patients, but there were symptoms of abdominalgia, fever, nausea, vomiting and flatulence of varying de-grees after interventional operation, and these symptoms were relieved by symptomatic treatment in one week. All patients in group A completed the treatment. Ⅰ-Ⅱ degree gastrointestinal tract reactions occurred in 3 cases, Ⅰ-Ⅱ degree myelosuppression occurred in 2 cases, and they were all completely relieved after treatment. The stent patency rate at 4, 6 and 12 months was 90%, 70%, 30% in group A; and 50%, 25%, 16.7% in group B (P < 0.05). The survival rate at 3, 6 and 1 2 months was 100%, 80%, 30% in group A and 91.7%, 41.7%, 16.7% in group B (P < 0.05). Conclusion Stent implantation combined with three-dimensional conformal radiation therapy is a good treatment for hepatocellular carcinoma with portal vein tumor thrombus and causes less damage to liver.