门静脉癌栓血管内射频消融联合支架植入近中期临床观察:初步经验

目的 观察Habib~(TM) Ves Open射频消融导管对门脉癌栓进行血管内治疗联合覆膜支架植入的临床效果,探索术中门脉癌栓组织活检的安全性和可行性。方法选择自2014年6月~2015年12月肝癌门脉癌栓患者13例,应用Habib消融导管血管内射频消融联合覆膜支架植入治疗。在造影了解癌栓的部位、范围后;采用5F活检钳在透视下对癌栓抓取活检共3例;然后自鞘内送5F Habib~(TM) Ves Open射频消融导管至癌栓对癌栓行逐段消融,结束后对消融段植入覆膜支架。术后观察患者临床症状改善情况及生存状况,并实验室相关指标复查及影像学检查,观察门静脉癌栓消融治疗后的状态3~18个月。结果 所有13例患者均顺利实施了血管内射频消融联合覆膜支架植入,无严重并发症发生。3例Ⅱ型癌栓者成功活检送病理,2例增生型,1例坏死型。9例上腹胀满者术后明显缓解;4例合并腹腔积液者中2例明显缓解,2例完全消失;1例顽固性腹泻者术后第3天停止。随访3~18个月,6例Ⅱ型癌栓者病情稳定,消融通道血流通畅,1例Ⅱ型、5例Ⅲ型和1例Ⅳ型癌栓者先后出现癌栓进展,消融通道狭窄甚至闭塞。生存时间超过3个月者12例;超过6个月10例;超过12个月8例;超过18个月5例。结论Habib TM Ves Open消融导管对门脉癌栓进行血管内射频消融联合覆膜支架植入可能获得比单纯血管内消融更好的疗效。在血管鞘的保护下,用活检钳对癌栓进行抓取活检技术上是安全可行的。

Endovascular radiofrequency ablation of portal vein tumor thrombus with HabibTM VesOpen catheter combined with covered-stent placement:a pilot clinical study

Objective To evaluate the efficacy of endovascular radiofrequency ablation with Habib TM VesOpen catheter combined with covered-stent placement in biopsy and treating portal vein tumor thrombus (PVTT). Methods 13 patients with PVTT were treated from June 2014 to December 2015. After confirming the location and extent of PVTT , biopsy was performed on 3 patients using 5F biopsy forceps under fluoroscopy. Radiofrequency ablation of the tumor thrombi was then performed using 5F HabibTM VesOpencatheter with the power of 10W for 3 minutes followed by insertion of covered-stent at the location of PVTT. The patients were followed up for 3-18 months by clinical observation, biochemical examination, color Doppler ultrasound, CT, and MRI. Results The procedure was successful in all patients with no complications. Abdominal distension was relieved (9), ascites resolved (2) or was reduced (2),and diarrhearesolved (1). During follow-up, the patients were stable (6)with survival of more than 3 months (12), 6 months (10), 12 months (8), and 18 months (5). The shunt was obstructed in 7 patients. Conclusion Endovascular radiofrequency ablation combined with covered-stent placement may be better than endovascular radiofrequency ablation alone in treating portal vein tumor thrombus. It is safe under the protection of the sheath to biopsy the tumor thrombus with forceps.