经皮激光消融治疗肝癌门静脉癌栓

目的总结经皮门静脉穿刺激光消融（laser ablation,LA）治疗肝癌门静脉癌栓的可行性。方法超声引导下经皮经肝门静脉穿刺,穿刺针准确穿入癌栓的中心轴,直达癌栓的最近端,导入光纤,脉冲激光照射。结果102例（94.4%）LA治疗后1～3d发热（体温37.5～39.5℃）;84例（77.8%）有穿刺点附近疼痛;3例（2.8%）术后出现上消化道出血。53例经皮LA治疗后生存满1年的癌栓变化：①LA治疗后癌栓萎缩,直至癌栓消失,20例;②LA治疗后癌栓萎缩,门静脉呈蜂窝状变,18例;③LA治疗后癌栓不缩小甚至继续生长,门静脉增宽,15例。95例术前门静脉癌栓支完全无血流信号,LA治疗后第1天均再次观察到彩色血流信号,LA治疗后1个月76例癌栓部位门静脉支观察到彩色血流信号,3个月64例（共91例）,6个月52例（共71例）,1年36例（共42例）,2年10例（共14例）,3年2例（共2例）。寿命表法统计1、2、3年的生存率分别为55.56%、35.20%、20.30%。结论经皮LA治疗肝癌门静脉癌栓可行。     

肝癌并门静脉癌栓的外科治疗

目的:探讨术中连续门静脉灌注化疗治疗原发性肝癌并门静脉癌栓的治疗效果。方法:将38例肝癌并门静脉癌栓患者随机分为治疗组19例和对照组19例，治疗组术中实施连续门静脉灌注化疗+肝癌切除+癌栓取除术，对照组术中仅行肝癌切除+癌栓取除术。术后两组均行门静脉和/或肝动脉置管化疗。结果:A组与B组术后7 d和30 d的AFP阴性率间明显高于B组(P>0.05)，A组1，3年复发率显著低于B组(P<0.05)，1，3年生存率明显高于B组(P<0.05)。结论:术中连续门静脉灌注化疗+肝癌切除+癌栓取出术+术后门静脉和/或肝动脉置管化疗是治疗肝癌伴门静脉癌栓的一种效果较满意的方法。     

肝癌射频治疗后超声多普勒技术对肝脏及肿瘤内血流动力学变化的评价

目的利用彩色能量频谱多普勒显像技术对肝癌集束电极射频治疗术前后肿瘤的血供情况、肝动脉、门静脉血流动力学进行观察,评价肝癌射频治疗效果. 方法采用美国GE公司Logiq-200型彩色能量多普勒血流显像对100例肝癌127个肿块集束电极射频治疗术前,术后1周、1个月及3个月肝脏及肿瘤的血流动力学变化进行观察. 结果集束电极射频治疗后1周、1个月肝动脉血流速度较术前明显降低,门脉血流速度无明显变化,瘤体内动静脉双重血供明显减少,Ⅱ、Ⅲ级供血明显减少.45例3个月复查,15例经彩色、能量多普勒检查有血供,频谱多普勒示动脉血供8例,门静脉血供3例,双重血供4例,经化疗栓塞、射频治疗后未发现血流.76例原发性肝癌中,术前15个肿块彩色多普勒检测无血流显示,更换能量多普勒后其中8个肿块有点状或细条状血流信号;术后1周98个肿块彩色多普勒检测无血流显示,更换能量多普勒后,其中16个肿块有点状或细条状血流信号,再次予射频治疗后,彩色及能量多普勒检测均未显示血流信号. 结论彩色、能量多普勒观察肝癌射频治疗前后血流的变化,可以评价肝癌射频治疗效果,能量多普勒在判断肝癌组织的微小血供及射频治疗是否彻底方面优于彩色多普勒,可作为评价疗效的首选方法.     

腔内导管射频消融联合TACE治疗原发性肝细胞癌门静脉癌栓的疗效观察

目的评价采用Habib~(TM) VesOpen血管内射频消融导管行经皮穿刺射频消融联合TACE治疗原发性肝细胞癌门静脉癌栓的疗效和安全性。方法选择原发性肝细胞癌合并门静脉主干或主要分支内癌栓患者39例,采用Habib~(TM) VesOpen腔内导管射频消融联合TACE治疗,评价手术成功率、术后并发症、血液指标、甲胎蛋白、门静脉通畅及癌栓的影像学变化情况。结果 39例患者手术均顺利完成,未发生血管穿孔、感染、肝脓肿、腹腔出血等与手术相关的并发症;术后2周、4周血常规(白细胞、红细胞、血小板计数)与术前比较差异无统计学意义(P均0.05);肝功能除总胆红素外,丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、血清白蛋白手术前后比较差异有统计学意义(P均0.05);甲胎蛋白手术前后比较差异有统计学意义(P0.05)。术后4周多普勒超声检查提示原堵塞门静脉均有血流通过;术后8周行上腹部增强CT检查或MR检查,提示患者癌栓有不同程度变小或消失。结论采用Habib~(TM) VesOpen血管内射频消融导管经皮穿刺门静脉内癌栓射频消融具有可行性,有望成为治疗原发性肝细胞癌门静脉癌栓的有效手段。     

腔内导管射频消融联合TACE对原发性肝癌患者门静脉癌栓的疗效及安全性分析

目的 了解腔内导管射频消融联合TACE对原发性肝癌患者门静脉癌栓的疗效及其安全性.方法 收集2016年1月至2018年10月本院经治原发性肝癌合并门静脉癌栓患者60例.依据抽签法分为观察组(30例)与对照组(30例).对照组:给予TACE治疗.观察组给予TACE+腔内导管射频消融治疗.监测术前及术后4周AFP、门静脉再...     

彩色多普勒超声监测肝移植术后门静脉并发症

目的 探讨彩色多普勒超声(CDI)监测肝移植术后门静脉并发症的应用价值。方法 对107例次原位肝移植患者于术前、术后应用CDI进行连续监测，监测指标包括门静脉主干内径、血流速度、血流量、血流频谱、侧支循环及腹水量等。结果 4例受者术后出现门静脉并发症：门静脉狭窄2例，门静脉狭窄并血栓形成1例，门静脉右支闭塞1例。2例门静脉主干血流量明显减少者接受经皮腔内血管成形术治疗后，门静脉高压缓解；而CDI提示门静脉血流量末见下降的2例患者，仅接受保守治疗，存活时间均超过1年。结论 彩色多普勒超声动态检查对肝移植术后门静脉并发症较为敏感，作为无创性检查手段可用于肝移植术后门静脉并发症的监测。     

超声引导下经皮激光消融治疗甲状腺微小乳头状癌(附3例报告)

目的:探讨超声引导下经皮激光消融(percutaneous laser ablation,PLA)治疗甲状腺微小乳头状癌的可行性、安全性及治疗效果。方法:对3例单发甲状腺微小乳头状癌行超声引导下PLA治疗。术后采用常规超声,随访观察消融灶大小、血供,术后即刻和术后3 d采用超声造影评价激光消融范围,并观察有无并发症发生。术后30 d对消融灶进行超声引导下细针穿刺活检。结果:3例均采用局部麻醉,成功进行PLA治疗,未发生严重并发症。术后常规超声随访,发现原病灶消失,消融区无彩色血流信号。术后即刻和术后3 d超声造影,显示消融区无造影剂灌注,完全覆盖原病灶。术后30 d超声引导下细针穿刺活检,可见坏死组织及炎性细胞,未见肿瘤细胞。结论:超声引导下PLA治疗是一种安全、有效、可行的方法。     

手术切除与射频消融对原发性肝癌合并Ⅰ型门静脉癌栓的临床疗效观察

目的 比较手术切除与射频消融术(RFA)治疗原发性肝癌合并Ⅰ型门静脉癌栓(portal vein tumor thrombus,PVTT)临床效果.方法 回顾分析2006年1月至2009年12月我院收治的30例原发性肝癌合并Ⅰ型门静脉癌栓患者的临床资料.结果 手术切除组(n=15)和射频消融组(n=15)均顺利完成治疗,无围手术期死亡病例.分析显示手术切除和射频消融治疗均能使患者获益.射频消融的疗效与手术切除接近,而且微创安全、并发症少.结论 外科手术切除肝肿瘤病灶+门静脉癌栓取出术以及射频消融术均是治疗原发性肝癌合并Ⅰ型门静脉癌栓的安全、有效的方法,均能改善患者的预后、降低肿瘤的复发.     

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1　概述近 30年来 ,原发性肝癌 (ＨＣＣ ,简称肝癌 )的诊治取得了很大进展 ,以手术为主的综合治疗使部分病人获得治愈。但肝癌有侵犯血管尤其是门静脉的生物学特性 ,根据尸检、影像学及肝癌病理学检查 ,2 0 %～ 70 %的ＨＣＣ合并有门静脉癌栓 (ｐｏｒｔａｌｖｅｉｎｔｕｍｏｒｔｈｒｏｍｂｕｓ,ＰＶＴＴ) [1] 。门静脉癌栓的出现使大部分病人失去手术或其它有效治疗措施的机会 ,也是导致肝癌转移复发、影响预后的主要因素。门静脉主支癌栓导致门静脉压力明显升高 ,随之而来的食道胃底静脉曲张破裂出血、腹水及肝功能衰竭等并发症严重影响肝…     

经皮经肝穿刺注射碘油化疗药物治疗原发性肝癌门静脉癌栓的临床研究

目的观察彩色多普勒超声定位引导下经皮注射碘油化疗药物乳剂治疗原发性肝癌并发门静脉癌栓的临床疗效。方法对21例患者,以21G注射针经皮经肝穿刺进入门静脉癌栓内,在超声监视下缓慢注射吡柔比星与超液化碘化油乳剂。结果21例患者前后共接受56次序贯治疗。治疗2～3次后15例患者癌栓缩小,其内可见条状静脉血流通过,有效率为71.43%。结论经皮经肝穿刺门静脉癌栓序贯注射碘油化疗药物乳剂是原发性肝癌并发门静脉癌栓的有效治疗手段。     

肝细胞癌合并门静脉癌栓的外科治疗

目的探讨肝细胞癌伴门静脉癌栓的外科治疗方法。方法回顾性分析我院2000年1月～2006年12月收治的肝细胞癌合并门静脉癌栓63例的临床资料。根据治疗方式的不同分为综合治疗组(21例)、门静脉取栓组(12例)和姑息治疗组(30例),比较各组的生存期。结果综合治疗组、门静脉取栓组和姑息治疗组的中位生存时间分别为12.7个月、7.4个月和4.3个月,有显著性差异(P<0.05)。综合治疗组、门静脉取栓组的疗效均明显优于姑息治疗组。结论对于能耐受手术的门静脉癌栓病人应积极行肝癌切除术并术中取栓治疗。     

巨块型肝癌合并门静脉癌栓的治疗：附15例报告

目的　探讨外科手术、肝动脉化疗栓塞及联合或不联合门静脉灌注化疗治疗巨块型肝癌伴门静脉癌栓的效果。方法　 15例伴有门静脉癌栓的巨块型肝癌 ,均采用切除原发癌灶并取尽癌栓治疗 ,其中 5例患者留置门静脉化疗泵 ,术后 2周行肝动脉化疗栓塞或联合门静脉化疗。结果　全组术后无严重并发症发生。 6,12 ,18个月生存期分别为 10 0 % (15 /15 ) ,80 .0 % (12 /15 ) ,60 .0 %(9/15 )。结论　手术仍是治疗巨块型肝癌合并门静脉癌栓的有效方法 ,手术后辅以介入为主的综合治疗能有效提高生存率。     

Portal vein tumor thrombus from colorectal cancer with no definite metastatic nodules in liver parenchyma

Portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) is a common entity. In colorectal liver metastasis, microscopic tumor invasion into the intrahepatic portal vein is also usually observed, but the incidence of macroscopic tumor thrombus in the first branch and trunk of the portal vein is rare. Most reported cases of PVTT from colorectal cancer had concomitant metastatic nodules in liver parenchyma, and the PVTT was continuous with the liver nodule, like PVTT in HCC. We present a case of PVTT from colorectal cancer with no definite metastatic nodules in liver parenchyma. A 58-year old man underwent laparoscopic high anterior resection for rectosigmoid carcinoma accompanied by bulky tumor thrombus in the branch of the inferior mesenteric vein. Six months later, he received left lobectomy and left caudate resection for liver metastasis. The resected specimen demonstrated there was no metastatic nodule in liver parenchyma and that the left portal system was filled with the tumor thrombus. The patient is alive with no sign of recurrence 66 months after hepatectomy. Even if there is a macroscopic PVTT from colorectal cancer, a better prognosis may be expected when the tumor can be completely resected en-bloc by anatomic hepatectomy including PVTT.     

肝癌合并门静脉或胆管癌栓的综合治疗

The prognosis of hepatocellular carcinoma (HCC)is poor,and tumor thrombus in the portal vein or in the bile duct is an important influencing factor.Approximately 30%of HCC patients are found to have portal vein tumor thrombus (PVTT)when diagnosed,and their median survival time is about 2.7-4.0 months if they do not receive any treatment.The incidence of HCC complicated with bile duct tumor thrombus (BDTT)is less than 10%,while the prognosis is dismal.Once tumor thrombus extends to the major bile ducts,obstructive jaundice and subsequent hepatic dysfunction are inevitable.The survival time of patients with HCC complicated with BDTT is less than 4 months if they only receive palliative biliary stenting.The management of HCC complicated with PVTT or BDTT is challenging with controversy at present.Different treatment approaches and their benefits for patients with HCC complicated with PVTT or BDTT are introduced in this paper.     

肝细胞癌伴门静脉癌栓的基础与临床研究

目的　探讨肝细胞癌 (HCC)病人门静脉癌栓 (PVTT)不同治疗方法的疗效及PVTT形成的生物学行为与发病机制。方法　回顾性分析 1 995年至 2 0 0 2年间的 2 6 0例HCC伴PVTT病人 ,按不同治疗方法分为 :①肿瘤切除并门静脉取栓组 (S1 =6 2 ) ;②门静脉取栓组 (S2 =5 4 ) ;③介入治疗组 (N1 =4 8) ;④保守治疗组 (N2 =96 )。比较各组间不同的疗效。实验研究对 1 2 3例HCC病人手术切除标本分为 3组 :无PVTT肝癌组 (B)、伴有PVTT的原发癌组 (A1 )及门静脉癌栓组 (A2 )。分析多种基因在癌组织中的表达及在PVTT形成中的意义。结果　S1 组中位生存期为 1 7.2个月 ,术后 1、3、5年生存率分别为 6 7.7%、4 0 .3%和 2 0 .9% ;S2 组中位生存期为 1 2 .6个月 ,术后 1、3、5年生存率分别为33.3%、2 2 .2 %和 7.4 %。N1 组中位生存期为 4 .8个月 ,术后 1、3、5年生存率分别为 2 0 .8%、6 .2 %和0 ;N2 组中位生存期为 1 .5个月 ,1、3、5年生存率分别为 5 .2 %、0、0。各组生存率比较 ,均有显著性差异(P <0 .0 1 )。VEGFmRNA、蛋白的表达率及MVD计数A1 组、A2 组织组均高于B组 ,表达强度A2 组高于A1 组 (P <0 .0 1 ) ;uPA、uPARmRNA及蛋白阳性表达率A2 组和A1 组均高于B组 ,表达强度A2组高于A1 组 (P <0 .0 1 )。E CD蛋白表达     

Treatment for hepatocellular carcinoma with tumor thrombosis in the hepatic vein or inferior vena cava: A comprehensive review

Hepatocellular carcinoma (HCC) is the most common type of liver cancer with a high mortality rate worldwide. The percentage of HCC patients with vascular invasion is high. However, tumor thrombus in the hepatic vein (HVTT) has a lower incidence than tumor thrombus in the portal vein (PVTT). Conventionally, HCC patients with HVTT are treated the same as HCC patients with PVTT and offered sorafenib or other systemic agents. However, according to recent studies, it is evident that HCC with HVTT shows different outcomes when classified into different subgroups. In this review, we discuss the recent progress and changes in treatment of HCC with HVTT.     

Surgical treatment of hepatocellular carcinoma in China

Background and aims Surgery remains the most effective treatment for hepatocellular carcinoma (HCC). While resection and liver transplantation achieve the best outcomes in patients with small HCC, controversy surrounds treatment of large HCC, HCC with portal vein tumor thrombus, and HCC with hypersplenism.Patient/methods From January 1988 to December 2002, 2,102 patients with large HCC underwent hepatectomy in our hospital. The traditional resection method was used on 959 patients, after which the improved new method was used on 1,143 patients. Meanwhile, from January 1990 until December 2003, hepatic resection ± thrombectomie has been performed in 438 patients with HCC and portal vein tumor thrombus. Among them, 286 patients showed portal vein tumor thrombus located in the primary and secondary branch of the main portal vein (group A), and 152 patients showed portal vein tumor thrombus (PVTT) involved in the main portal vein (group B). Additionally, out of 204 HCC patients with cirrhotic hypersplenism, 94 patients had hepatectomy and splenectomy, and 100 patients had only hepatectomy without hospital death.Results The 3- and 5-year survival after resection of large HCCs (over 5 cm) with improved new method in China was between 50.7 and 58.8% and 27.9 and 38.7%, respectively. Tumor recurrence in the liver within 1 year after hepatic resection + thrombectomie was detected in 45% of group A and in 78.8% in group B. The cumulative 5-year overall survival rates were 18.1% for group A and 0% for group B. The 1-, 3-, and 5-year overall survival in HCC plus portal vein tumor thrombus (PVTT) was 58.7, 22.7, and 18.1%. The hepatectomy/splenectomy group had a 5-year tumor-free survival rate of 37.2% and the hepatectomy group alone had 27.2%.Conclusion The new resection methods, hepatic resection + thrombectomy and hepatectomy + splenectomy, are very effective treatments for large HCC, HCC with portal vein tumor thrombus, and HCC with hypersplenism, respectively. Local treatment modalities, e.g. percutaneous ethanol injection, cryosurgery, and radiofrequency ablation as well as microwave coagulation are used in patients with poor liver function in small and large HCCs.     

Liver Resection with Portal Vein Thrombectomy for Hepatocellular Carcinoma With Vascular Invasion

Introduction  Hepatocellular carcinoma (HCC) tends to invade the intrahepatic vasculature, especially the portal vein.1 The presence of portal vein tumor thrombus (PVTT) in patients with HCC is one of the most significant factors for a poor prognosis.2 ^– 5 The presence of macroscopic PVTT in patients with HCC is also a significant factor for poor prognosis, with a median survival of <3 months without treatment.1 In surgically resected series, in patients with gross PVTT (PVTT in the portal trunk, its first-order branch, or its second-order branch), the 3-year and 5-year survival rates are reportedly 15% to 28% and 0% to 17%, respectively.2 ^– 5 Methods  The patient was a 77-year-old woman with well-compensated hepatitis C virus–related cirrhosis (stage A6 according to Child-Pugh classification) who sought care at our department for vague abdominal discomfort. Triphasic spiral computed tomographic scan confirmed HCC 6 cm in diameter in the left lobe of the liver. In addition, portal vein tumor thrombosis of the left branch that extended to the right portal vein was present. Results  The procedure included left hepatectomy and en-bloc portal vein thrombectomy with clamping of both the common portal vein trunk and the right portal vein. The portal vein was incised at the bifurcation of the right and left portal veins, and the thrombus was extracted from the incision in the portal vein. With this procedure, we were able to examine under direct vision the exact extent of the portal vein thrombus, and we identified whether the tumor thrombus was adherent to the venous wall or was freely floating in the venous lumen. Portal clamping and length of operation were 16 and 330 minutes, respectively. Intraoperative blood loss was 550 mL. The patient was discharged on postoperative day 6, and she was free of disease at 15 months after surgery. Discussion  Liver resection should be considered a valid therapeutic option for HCC with PVTT. Electronic supplementary material  The online version of this article (doi:) contains supplementary video material, which is available to authorized users. Presented to Annual Meeting of the American Hepato-Pancreato-Biliary Association (AHPBA), Miami, Florida, USA, March 9-12, 2006.     

肝癌合并门静脉癌栓形成机制及治疗方法

肝细胞性肝癌是全世界常见的恶性肿瘤之一.近年来,随着影像学的发展,越来越多的肝细胞性肝癌在早期即能被发现,但是,其中11％～42％的肝癌患者已有门静脉侵犯,即门静脉癌栓的形成.门静脉癌栓的形成使肿瘤细胞在肝脏中广泛传播并引起肝功能的进一步恶化.过去常被认为不宜行手术治疗,多采用保守治疗或放弃治疗,大多数患者在数月内死亡,即使有机会行手术切除,术后多辅以经导管肝动脉栓塞化疗术、门静脉支架植入或门静脉化疗等治疗方式,部分患者能更长时间的存活,但由于微小癌栓及微小转移灶术前已存在,术前检查难以发现,手术取栓很难清除干净,容易导致术后肝癌早期复发.随着科学技术的不断进步及对门静脉癌栓形成机制的进一步认识,越来越多的治疗新技术被应用于临床.本文主要就门静脉癌栓形成机制及经典的经导管肝动脉栓塞化疗术和一些新的治疗方法,如螺旋断层放疗、CIK细胞治疗、经导管肝动脉栓塞化疗术联合门静脉支架植入后125I放疗进行综述.