合并门静脉癌栓的原发性肝癌的综合介入治疗

目的评价CT引导下经皮射频消融（RFA）＋经导管肝动脉化疗栓塞术（TACE）为主,必要时联合经皮无水乙醇注射（PEI）及三维适形放疗（3D-CRT）治疗合并门静脉癌栓（PVTT）的原发性肝癌的疗效。方法对38例侵犯门静脉的原发性肝癌患者先行TACE治疗,再行CT引导下RFA治疗,根据肿瘤位置以及是否侵犯门静脉主干,联合应用PEI或3D-CRT治疗。以mRECIST标准为评价指标。结果联合治疗侵犯门静脉的原发性肝癌总体完全缓解（CR）率为42.11%（16/38）,部分缓解（PR）率为15.79%（6/38）,稳定（SD）率为2.63%（1/38）,进展（PD）率为39.47%（15/38）。结论以TACE＋RFA治疗为主,必要时联合PEI和3D-CRT治疗侵犯门静脉的原发性肝癌,方法安全,疗效显著。

Combination therapy of primary liver cancer with portal vein tumor thrombus

Objective To evaluate the clinical curative effect of transcatheter hepatic arterial chemoembolization (TACE), radiofrequency ablation (RFA) and, when necessary, combined with percutaneous ethanol injection (PEI) or three dimensional conformal radiotherapy (3D-CRT) in the treatment of primary liver cancer patients with portal vein tumor thrombus (PVTT). Methods Thirty-eight patients with primary liver cancer invading portal vein were treated with TACE and RFA guided by CT as well as combined with PEI and/or 3D-CRT when necessary. The clinical effect was evaluated through the standard of mRECIST. Results The rate of complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) of the combination therapy was 42.11% (16/38), 15.79% (6/38), 2.63% (1/38) and 39.47% (15/38), respectively. Conclusion TACE+RFA and, when necessary, combined with PEI or 3D-CRT is safe and effective in the treatment of primary liver cancer patients with PVTT.