内支架置入对不同类型下腔静恶性梗阻的临床价值

目的评价内支架置入对不同类型下腔静脉(IVC)恶性梗阻的临床价值。方法84例肝癌伴IVC梗阻患者经MRA和(或)DSA检查,分为外压型和栓塞型IVC梗阻。其中,47例外压型IVC梗阻分为支架置入组26例(A组)和对照组21例(B组);37例栓塞型IVC梗阻分为支架置入组20例(C组)和对照组17例(D组)。有适应证患者,均行肝动脉化疗栓塞(TACE)。结果经治疗后,A组和C组患者近期(1周内)梗阻症状缓解率分别为96.2%和90.0%(P>0.05);中期(6周后)梗阻症状缓解率分别为84.6%和30.0%(P<0.05);支架内再梗阻率分别为30.8%和75.0%(P<0.05)。A组和B组患者中位生存期分别为300d和120d(P<0.05)。C组和D组患者中位生存期分别为67d和55d(P>0.05)。结论对于外压型IVC梗阻,置入内支架能显著改善患者梗阻症状,延长生存期,主张积极施行内支架置入术;对于栓塞型IVC梗阻,置入内支架后发生再梗阻率较高,并不能延长生存期,可作为一种有限的姑息性治疗手段。

Clinical evaluation of slanting for different types of malignant inferior vena cava obstruction

Objective To evaluate the clinical outcome of stenting for different types of malignant inferior vena cava(IVC)obstruction.Methods Eighty-four liver cancer patients complicated with IVC obstruction were divided into external compression type and embolic type by magnetic resonance angiography(MRA)and/or digital subtraction angiography(DSA).Of the 47 cases with external compression type,26 patients were undergone interventional stent placement(group A)and the other 21 patients were served as control group(group B).Of the 37 cases with embolis type,20 patients were stented(group C)and remaining 17 patients were in control group(group D).Transarterial chemo-embolization(TACE)were performed for those patients without contraindications.Results Within one week remission rates of clinical symptoms were 96.2% and 90.0% in group A and group C(P > 0.05),after six weeks remission rates were 84.6% and 30.0%,respectively(P < 0.05).Re-obstruction rates in these two groups were 30.8% and 75.0%,respectively(P < 0.05).The median survival term was 300 days in group A and 120 days in group B(P < 0.05),and those in group C and group D were 67 days and 55 days,respectively(P > 0.05).Conclusions Interventional stent placement is recommended for patients with external compression IVC obstruction,with significant relief of the clinical symptoms and prolongation of the survival term.For embolic type of IVC obstruction patients,stenting is only a short-term palliative modality because of higher re-obstruction rate and shorter survival term.