门静脉金属内支架结合经动脉化疗栓塞手术治疗肝癌门静脉癌栓

目的:探讨门静脉金属内支架结合经动脉化疗栓塞术(TACE)治疗肝癌合并门静脉癌栓的临床效果.方法:11例盱癌门静脉癌栓患者采用肝穿刺途径置入门静脉金属内支架,同时(或1周后)行TACE.记录手术成功、狭窄开通、并发症和手术死亡发生情况,随访支架通畅期和患者生存期.结果:门静脉通路穿刺成功率11/11;门脉支架置入成功率10/11;发生肝性脑病及肝功能衰竭1例.支架中位通畅期5.7个月(1～18个月);治疗后3个月、6个月及1年患者生存率分别为5/11、4/11、2/11.结论:对巨块型肝癌合并门静脉癌栓、但无远处广泛转移的患者,采用支架开通门脉主干及远端为非肿瘤所在肝叶的门脉,结合TACE治疗,可取得较好的疗效.

Portal vein stenting combined with transcatheter hepatic arterial chemoembolization in treatment of portal vein tumor thrombus in patients with primary hepatic carcinoma

Objective:To discuss the clinical outcomes of portal vein stenting combined with transcatheter hepatic arterial chemoembolization(TACE) in treating portal vein tumor thrombus in the patients with primary hepatic carcinoma(PHC).Methods: Eleven PHC patients with tumor thrombus in the main branch or trunk of the portal vein were treated with stenting and TACE simultaneously(or TACE were performed 1 week later).The successful rate of the procedure,the patency of the obstruction,the complications,the mortality and the survival periods were all recorded.Results: Portal vein puncture was successfully performed in all 11 cases and successful stenting was achieved in 10 cases.Hepatic encephalopathy combined with hepatic failure was noticed in 1 patient.The median patency period after stenting was 5.7(118) months.The survival rates of patients at 3,6 and 12 months after treatment were 5/ 11,4/ 11 and 2/ 11,respectively.Conclusion: Metallic stent implantation combined with TACE has satisfactory outcome in treating tumor thrombus in the main branch and trunk of the portal vein in PHC patients without distant metastases.