布加综合征合并肝细胞癌的介入治疗

目的 探讨布加综合征合并肝细胞癌介入治疗的效果.方法 回顾性分析17例布加综合征合并肝细胞癌患者的临床资料.布加综合征经彩色多普勒超声及血管造影确诊;肝细胞癌5例由肝穿刺细胞学检查确诊,12例由彩色多普勒超声、CT或MRI及甲胎蛋白(AFP)进行综合诊断.所有患者均施行下腔静脉成形术及动脉化疗栓塞术(TACE).术后随访采用肝脏超声、CT及实验室检查,观察肿瘤大小、肝功能、AFP及下腔静脉通畅情况.采用t检验比较介入治疗前后压力变化.结果 17例患者共进行了39次介入治疗,均成功,无并发症.下腔静脉成形术后:患者随访2～90个月,1例下腔静脉再闭塞,经第2次血管成形术开通.TACE术后:2个月时随访,所有患者均生存;15例随访6个月,13例生存;12例随访12个月,10例生存;8例随访24个月,5例生存.介入治疗后,下腔静脉-右心房压力差由术学的(20.5±2.1)cm H2O(1cm H2O=0.098 kPa)降至(3.6±1.0)cm H2O,差异有统计学意义(t=30.32,P＜0.05).结论 布加综合征合并肝细胞癌的介入治疗可取得较好临床效果.

Interventional treatment of hepatocellular carcinoma complicated by Budd-Chiari syndrome

Objective To evaluate the efficacy of interventional therapy for hepatocellular carcinoma complicated by Budd-Chiari syndrome. Methods Clinical data and imaging studies of 17 patients with hepatocellular carcinoma complicated by Budd-Chiari syndrome were retrospectively analyzed. Budd-Chiari syndrome was diagnosed by color Doppler ultrasound and confirmed by cavography in 17 patients. Hepatocellular carcinoma was diagnosed by fine-needle aspiration cytology in 5 patients,and by color Doppler ultrasound, computed tomography and /or MRI, and elevated level of alpha-fetoprotein in 12 patients. Both percutaneous transluminal angioplasty for treatment of obstruction of the inferior vena cava and transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma were performed in all patients. During follow-up, the tumor size, liver function, serum alpha-fetoprotein level and the recanalized inferior vena cava were evaluated by liver ultrasound, CT and laboratory examination. t test was used to compare the pressure. Results Thirty-nine interventional procedures were performed in 17 patients and all operations were successful without complications. Over the follow-up period of 2 to 90 months after percutaneous transluminal angioplasty in 17 patients, re-occlusion of inferior vena cava occurred in only one patient, which was redilated successfully. Following TACE, all 17 patients survived at two months followup, 13 patients survived at 6 months follow-up, 10 patients survived at 1 year follow-up, 5 patients survived at 2 years follow-up. The pressure of vena cava was (20.5±2.1) cm H2O (1cm H2O=0.098 kPa) before the interventional theraphy, while it was (3.6±1.0) cm H2O after it (t=30.32, P＜0.05). Conclusion Interventional therapy can be effectively performed for treatment of hepatocellular carcinoma complicated by Budd-Chiari syndrome.