原发性肝癌合并门静脉癌栓不同治疗方法的疗效观察

目的评价原发性肝癌合并门静脉癌栓不同治疗方法的疗效。方法回顾性分析我院83例原发性肝癌伴门静脉癌栓患者的临床资料,根据不同的治疗方法分为肝癌手术切除+癌栓切除或取出+术后肝动脉化疗栓塞治疗组(A组),肝癌手术切除+癌栓切除或取出治疗组(B组),肝动脉化疗栓塞治疗组(C组)。结果 A组中位生存期17个月,术后0.5、1、3年生存率分别为92.1%、64.6%和19.1%。B组中位生存期12个月,术后0.5、1、3年生存率分别为58.3%、41.7%和7.1%。C组中位生存期5个月,术后0.5、1、3年生存率分别为37.0%、15.9%和0。各组生存率比较,差异均有统计学意义(P<0.05)。结论肝切除和门静脉取栓术是肝癌伴门静脉癌栓的有效治疗方法,术后联合肝动脉化疗栓塞能提高治疗效果,延长患者的生存期。     

不同方法治疗肝癌合并门静脉癌栓的疗效比较

目的 比较肝功能处于代偿期的肝癌合并门静脉癌栓患者不同治疗方法的疗效并探讨影响其疗效的因素。方法 50例肝癌合并门静脉癌栓患者，根据不同的治疗方法分为四组：保守治疗组12例、化疗组12例、手术切除组13例、手术切除加化疗组13例。结果 保守治疗组中位生存时间3．5个月；化疗组中位生存时间7．1个月；手术切除组中位生存时间10．3个月；而手术切除加化疗组中位生存时间13．4个月，术后0．5、1、2、3年生存率分别为53．7％、37．6％、30．7％、14．0％，明显高于其他三组（P〈0．05）。单因素、多因素分析提示术后化疗次数是影响手术切除后疗效的重要因素。结论 门静脉癌栓患者手术切除加术后化疗的疗效最好。     

调强放疗联合索拉非尼治疗肝细胞癌合并门脉癌栓的疗效及预后因素分析#br#

摘要：目的　探讨调强放疗（IMRT）联合索拉非尼治疗肝细胞癌（HCC）合并门脉癌栓（PVTT）的疗效、安全性及预后影响因素。方法　纳入76例HCC合并PVTT的患者,根据治疗是否同步索拉非尼分为IMRT+索拉非尼组（30例）和单纯IMRT组（46例）。比较2组临床一般资料、生存结局、不良反应。Kaplan-Meier法测定2年累积生存（OS）率、无进展生存（PFS）率、无远处转移生存（DMFS）率并行Log-rank检验,单因素及多因素Cox模型分析预后影响因素。结果　IMRT+索拉非尼组与单纯IMRT组客观缓解率（ORR）分别为53.3%、43.5%（P＞0.05）。IMRT+索拉非尼组中位生存时间长于单纯IMRT组（12.0个月vs. 9.0个月）。IMRT+索拉非尼组与单纯IMRT组2年OS分别为23.8%和3.5%（Log-rank χ2=6.271,P=0.012）,2年PFS分别为7.5%和0（Log-rank χ2=6.205,P=0.013）,2年DMFS分别为9.5%和0（Log-rank χ2=4.346,P=0.037）。多因素分析显示,未同步索拉非尼、AST/ALT>1.26、肿瘤无反应均为影响HCC合并PVTT患者生存质量的独立危险因素（均P＜0.05）。2组不良反应发生率差异无统计学意义（P＞0.05）。结论　与单纯IMRT相比,IMRT同步索拉非尼改善了HCC合并PVTT患者的远期疗效,而未增加不良反应。AST/ALT<1.26、肿瘤有反应、IMRT同步索拉非尼的患者预后较好。     

手术治疗肝癌合并门静脉癌栓的效果

目的探讨原发性肝癌(HCC)合并门静脉癌栓(PVTT)的外科治疗效果。方法 63例肝癌合并门静脉癌栓患者中,17例(A组)行肝癌切除加门静脉癌栓取栓术,术后再加大网膜静脉双插管灌注化疗;其余46例(B组)行非手术治疗,包括射频治疗24例、无水酒精注射14例、介入治疗8例。结果 A组术后1、2和3年的生存率分别为65.2%、41.2%、23.5%,明显高于B组的45.7%、28.3%和0%(P<0.05)。结论与非手术治疗比较,手术治疗能相对延长肝癌合并门静脉癌栓患者的生存时间,方便术后使用大网膜静脉插管灌注化疗。     

介入治疗原发性肝癌合并门静脉癌栓的疗效分析

目的探讨肝动脉化疗栓塞（TACE）联合门静脉化疗（PVC）泵置入术治疗原发性肝细胞癌（肝癌）合并门静脉癌栓的临床疗效。方法将94例肝癌合并门静脉癌栓患者按治疗方法分为TACE＋PVC组58例和TACE组36例。TACE＋PVC组采用超选择TACE联合PVC术治疗,TACE组单纯采用超选择性TACE术治疗。比较2组临床疗效。结果 TACE＋PVC组术后1、3、5年生存率分别为82.8%、43.1%、3.4%,高于TACE组的44.4%、16.7%、0,差异均有统计学意义（P〈0.05）。结论 TACE联合PVC泵置入术治疗肝癌合并门静脉癌栓临床疗效显著,且安全、有效。     

原发性肝癌合并门静脉癌栓治疗近况

肝癌包括肝细胞性肝癌胆管细胞性肝癌,门静脉癌栓是影响其预后及引起复发的重要因素.笔者就原发性肝癌合并门静脉癌栓的治疗近况做一综述.     

Transcatheter arterial chemoembolization vs. chemoinfusion for unresectable hepatocellular carcinoma in patients with major portal vein thrombosis

Background  Transcatheter arterial chemoembolization (TACE) has been limited in palliative treatment of unresectable hepatocellular carcinoma (HCC) with major portal vein (PV) invasion due to the possibility of liver failure following embolization. Transcatheter arterial chemoinfusion (TACI) has been an option in such cases.
Aim  To compare clinical outcomes after TACE vs. TACI in HCC patients with major PV occlusion.
Methods  We compared clinical outcomes after TACE vs. TACI in HCC patients with major PV occlusion. From 2005 to 2007, 110 HCC patients with major PV thrombosis were treated with TACE ( n  = 49) or TACI ( n  = 61).
Results  The morbidity rate was similar for both TACE (6.1%) and TACI (6.5%) patients, and complications were adequately managed using medical treatment. The Kaplan–Meier survival analysis showed that the survival period was significantly longer for the TACE group (median: 14.9 months) than for the TACI (median: 4.4 months) group ( P  < 0.001). There was a higher probability of death in the TACI group than in the TACE group in both our multivariate Cox-proportional hazards (OR 3.09, P  < 0.001) and the propensity score-matched (27 pairs) cohort analyses (OR 2.27, P  = 0.024).
Conclusions  Transcatheter arterial chemoembolization can be safely performed in HCC patients with main PV occlusion. Compared with TACI, TACE may result in longer survival of HCC patients with major PV occlusion.     

原发性肝癌门静脉癌栓的危险因素与预后分析

原发性肝癌（HCC）远期预后差,5年生存率5％～15％。目前认为,伴有门脉襄栓（portal vein tumor thrombosis,PVTT的肝癌因易发生肝内及远处转移．被认为是预后差的主要指标之一回。现回顾性分析原发性肝癌患者门静脉癌栓的危险因素及与预后的关系。     

Intra‐arterial therapy with cisplatin suspension in lipiodol and 5‐fluorouracil for hepatocellular carcinoma with portal vein tumour thrombosis

Aliment Pharmacol Ther 2010; 32: 543–550

Summary

Background Portal vein tumour thrombosis is a negative prognostic factor for hepatocellular carcinoma (HCC). Aim To assess the efficacy of cisplatin in lipiodol emulsion combined with 5‐fluorouracil (5‐FU) for patients with HCC and portal vein tumour thrombosis. Methods The study subjects were 51 patients with the above‐specified criteria who received injection of cisplatin suspension in lipiodol emulsion followed by intra‐arterial infusion of 5‐FU. The primary objective was to determine tumour response to the treatment, while the secondary objectives were safety and tolerability. Independent factors for survival were also assessed. Results Ten patients had complete response and 34 patients had partial response (response rate, 86.3%). The median survival for all 51 patients was 33 months, while that for 10 complete response patients and 21 patients who showed disappearance of HCC following additional therapies was 39 months. The single factor that significantly influenced survival was therapeutic effect. Treatment was well tolerated and severe toxicity was infrequent, with only grade 3 toxicity (thrombocytopenia) in one patient. Conclusions The present study demonstrated the efficacy of hepatic arterial infusion chemotherapy using cisplatin‐lipiodol emulsion and 5‐FU without serious adverse effects in patients with unresectable HCC and portal vein tumour thrombosis.     

原发性肝癌切除术后门静脉血流障碍的处理进展

门静脉血流障碍是原发性肝癌切除术后的一种少见的并发症,且临床表现不明显,病死率高,相关研究报道较少,仍未能引起临床医师足够重视.至今,对于原发性肝癌术后门静脉血流障碍的诊治尚未达成共识.近年来,随着临床诊疗技术的提高和对该并发症认识的深入,其对原发性肝癌切除术的患者治疗越来越受到肝胆外科医生的关注.该文针对原发性肝癌切除术后门静脉血流障碍的流行病学、病因及发生机制、临床表现、相关诊疗及预防作一综述.     

原发性肝癌合并门静脉癌栓肝移植术后27例随访报告

目的 探讨肝移植治疗原发性肝癌合并门静脉癌栓的价值。方法 收集我院2000年9月至2005年1月进行的27例原发性肝癌合并门静脉癌栓肝移植病例的临床资料并进行分析。结果 本组6个月、1年、2年生存率分别为79．2％、57．1％、51．4％，存活时间最长达46个月，6个月、1年和2年的无瘤生存率为58.3％、37．1％及37．1％。结论 如果没有肝外远处转移，肝移植治疗原发性肝癌合并门静脉癌栓是一种有效的姑息治疗方式。     

肝癌合并门静脉癌栓不同治疗方法疗效比较

目的探讨肝癌合并门静脉癌栓(TTPV)患者不同治疗方法的临床疗效。方法肝癌合并门静脉癌栓30例,按治疗方法不同分为A、B、C组,以生存质量评估疗效。结果A组1年生存率为100%,2年生存率40%,3年生存率20%。B组1年生存率为40%,2年生存率为0。C组1年生存率为20%,2年生存率为0。术前平均GLQI指数为(106±13)分,术后2~10周胃肠寿命质量指数(GLQI)明显下降(P<0.05~0.01),第4个月接近术前水平(P>0.05)。结论肝切除+门静脉取癌栓+肝动脉、门静脉双灌注化疗栓塞+生物治疗是治疗肝癌合并TTPV的有效方法。     

动脉化疗栓塞联合阿帕替尼治疗原发性肝癌伴门静脉瘤栓71例疗效分析

目的 探讨动脉化疗栓塞(TACE)联合阿帕替尼治疗原发性肝癌伴门静脉瘤栓疗效及安全性.方法 选择2016年1月至2017年6月华中科技大学同济医学院附属协和医院诊治的149例原发性肝癌伴门静脉瘤栓病人为研究对象,根据病人治疗方法分为TACE联合阿帕替尼组(71例)和单纯TACE组(78例),多因素Cox风险比例模型、生...     

临床药师参与1例肝硬化合并门静脉血栓患者的抗凝治疗

临床药师通过参与1例肝硬化合并门静脉血栓患者的抗凝治疗,探讨临床药师在临床治疗中发挥的作用。面对治疗矛盾,临床药师通过查阅相关指南、文献,在抗凝时机、抗凝药物的选择、给药方案优化及药学监护等方面为医师及患者提供临床药学服务,提高患者用药的有效性和安全性。     

门静脉高压症手术后门静脉血栓形成的原因

目的探讨肝硬化门静脉高压症术后门静脉血栓形成的原因。方法回顾分析86例采用肠腔分流术加脾切断流术联合手术和脾切断流术治疗的肝硬化门静脉高压症患者的临床资料,包括对年龄、性别、门静脉血流流速的变化、血小板数值等相关指标监测分析。结果门静脉高压症患者术后门静脉血栓形成率为18.60%,其中断流手术后门静脉系统血栓形成率为23.33%,联合手术后血栓形成率为7.69%。术后血栓组PV、SV的流速下降显著(P<0.05)。PVT患者的平均年龄大于无PVT患者(P<0.05)。性别,肝功能ch ild-pugh分级,凝血酶原时间等因素并非门静脉血栓形成的危检因素。结论门静脉系统血液流速减缓、年龄都是门静脉高压症术后门静脉血栓形成的危险因素。     

Ascites in patients with noncirrhotic nonmalignant extrahepatic portal vein thrombosis

Aliment Pharmacol Ther 2010; 32: 529–534

Summary

Background The clinical significance of ascites in patients with extrahepatic portal vein thrombosis (EPVT) has been poorly defined. Aims To assess the frequency, natural history and prognostic implication of ascites in patients with EPVT and to identify risk factors for this complication. Methods A single‐centre retrospective study of consecutive patients diagnosed with noncirrhotic nonmalignant EPVT between 1985 and 2009. Results One hundred and three patients [35% males; median age 43 (range 16–83) years] were included and followed up for a median time of 5.2 (range 0.9–32.5) years. Twenty‐nine (28%) had ascites at the time of diagnosis. Overall survival was 91% at 5 years vs. 80% at 10 years. Survival in patients presenting with and without ascites was 83% vs. 95% at 5 years and 42% vs. 87% at 10 years (P = <0.01). There was no correlation between the presence of ascites and extension of the thrombus into the large splanchnic veins, duration of thrombosis or presence of gastrointestinal bleeding. Conclusions Ascites is present in a quarter of patients presenting with noncirrhotic nonmalignant extrahepatic portal vein thrombosis. Ascites is a significant and independent prognostic factor and it is associated with a decreased long‐term survival.     

Systematic review: portal vein thrombosis in cirrhosis

Aliment Pharmacol Ther 31, 366‐374

Summary

Background As current imaging techniques in cirrhosis allow detection of asymptomatic portal vein thrombosis during routine ultrasonography, more patients with cirrhosis are diagnosed with portal vein thrombosis. Although a consensus on noncirrhotic extra‐hepatic portal vein thrombosis has been published, no such consensus exists for portal vein thrombosis with cirrhosis. Aim To perform a systematic review of nonmalignant portal vein thrombosis in cirrhosis in terms of prevalence, pathogenesis, diagnosis, clinical course and management. Methods Studies were identified by a search strategy using MEDLINE and EMBASE. Results Portal vein thrombosis is encountered in 10–25% of cirrhotics. In terms of pathophysiology, cirrhosis is no longer considered a hypocoagulable state; rather than a bleeding risk in cirrhosis, various clinical studies support a thrombotic potential. Clinical findings of portal vein thrombosis in cirrhosis vary from asymptomatic disease to a life‐threatening condition at first presentation. Optimal management of portal vein thrombosis in cirrhosis is currently not addressed in any consensus publication. Treatment strategies most often include the use of anticoagulation, while thrombectomy and transjugular intrahepatic portosystemic shunts are considered second‐line options. Conclusions Portal vein thrombosis in cirrhosis has many unresolved issues, which are often the critical problems clinicians encounter in their everyday practice. We propose a possible research agenda to address these unresolved issues.     

Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with and without cavernous transformation

BACKGROUND: Treatment options for patients with portal vein thrombosis are limited. AIM: To evaluate the feasibility and efficacy of transjugular intrahepatic portosystemic shunt for portal vein thrombosis with/without cavernomatous transformation. METHODS: A survey of such patients, referred for transjugular intrahepatic portosystemic shunt between 1994 and 2005, was performed. Success rates, complications, transjugular intrahepatic portosystemic shunt patency and clinical progression were examined. RESULTS: Transjugular intrahepatic portosystemic shunt was attempted in 28 patients (13 cirrhotics). Indications were: presurgery/transplantation (2), worsening of ascites (2), variceal bleeding (15 - 8 elective), refractory ascites (3), portal biliopathy (3) and portal vein thrombosis complicating Budd-Chiari syndrome (2). Transjugular intrahepatic portosystemic shunt was placed successfully in 19 of 28 (73%); 23 of 28 had complete portal vein thrombosis and 9 of 23 had cavernous transformation and transjugular intrahepatic portosystemic shunt was successfully placed in six of these. In the 19 patients with transjugular intrahepatic portosystemic shunt, the mean follow-up was 18.1 months (range 5-70): six patients had stent revisions; three had liver transplantation, one died of bleeding. Most cirrhotic patients had an improvement in the Child-Pugh score. In the failed transjugular intrahepatic portosystemic shunt group, two of nine died, and three had further bleeding. CONCLUSIONS: Transjugular intrahepatic portosystemic shunt should be considered for selected patients with symptomatic complete portal vein thrombosis with/without cavernous transformation, as clinical improvement and less rebleeding occur when transjugular intrahepatic portosystemic shunt placement is successful.