125I粒子条-门静脉支架联合经皮经肝曲张静脉栓塞预防肝细胞癌合并门静脉主干癌栓患者上消化道再出血

目的 观察¹²⁵I粒子条-门静脉支架联合经皮经肝曲张静脉栓塞（PTVE）预防肝细胞癌（HCC）合并门静脉主干癌栓（MPVTT）患者上消化道再出血的效果。方法 回顾性分析16例接受¹²⁵I粒子条-门静脉支架植入联合PTVE治疗的原发性HCC伴MPVTT患者，统计治疗后随访期间上消化道再出血、支架通畅性和生存时间。结果 16例均成功接受¹²⁵I粒子条-门静脉支架植入联合PTVE，未见严重治疗相关不良事件。随访15~1 620天，中位随访时间207天；期间10例发生上消化道再出血（其中4例死亡），中位再出血时间为185天，治疗后1、3、6及12个月累积无上消化道再出血率分别为87.50%、68.18%、53.03%及26.51%；5例门静脉支架闭塞，11例支架均通畅，中位支架通畅时间为252天，治疗后1、3、6及12个月累积支架通畅率分别为100%、93.33%、84.00%及31.50%。共14例死亡，中位生存时间为210天，治疗后1、3、6及12个月累积总体生存率分别为93.75%、74.04%、60.58%及13.46%。结论 ¹²⁵I粒子条-门静脉支架联合PTVE对预防HCC伴MPVTT患者上消化道再出血有一定效果。

125I seeds strand and portal vein stent combined with percutaneous transhepatic variceal vein embolization for preventing upper gastrointestinal rebleeding in patients with hepatocellular carcinoma and main portal vein tumor thrombus

Objective To observe the efficacy of ¹²⁵I seeds strand and portal vein stent combined with percutaneous transhepatic variceal vein embolization (PTVE) for preventing upper gastrointestinal rebleeding in hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT). Methods Data of 16 patients with primary HCC and MPVTT who underwent ¹²⁵I seeds strand and portal vein stent implantation combined with PTVE were retrospectively analyzed. Rebleeding of upper gastrointestinal tract, stent patency and overall survival rate were observed. Results ¹²⁵I seeds strand and stent implantation combined with PTVE were successful performed without serious procedure-related adverse events. During 207(15-1 620) days'' following-up, 10 patients suffered upper gastrointestinal rebleeding, the median rebleeding time was 185 days. One, 3, 6 and 12 months after treatments, the cumulative rate of no upper gastrointestinal rebleeding was 87.50%, 68.18%, 53.03% and 26.51%, respectively. Portal vein stents occludsion was detected in 5 cases, while stents remained patent in the rest 11 cases. The median stent patency time was 252 days, and 1, 3, 6 and 12 months after treatments, the cumulative stent patency rate was 100%, 93.33%, 84.00% and 31.50%,respectively. There were 14 deaths during the follow-up period, the median survival time was 210 days, and the cumulative overall survival rates at 1, 3, 6 and 12 months was 93.75%, 74.04%, 60.58% and 13.46%, respectively. Conclusion ¹²⁵I seeds strand and portal vein stent implantation combined with PTVE had a certain effect for preventing upper gastrointestinal rebleeding in patients with HCC complicated with MPVTT.