经导管动脉化疗栓塞术联合经皮 125I粒子植入序贯治疗肝癌伴门静脉主干癌栓

目的评价经导管动脉化疗栓塞术（TACE）联合经皮125I放射性粒子植入序贯治疗肝癌伴门脉主干瘤栓的临床疗效及安全性。 方法2010年1月至2012年3月48例确诊为肝癌合并门静脉主干癌栓患者，TACE术后1周进行经皮门脉瘤栓125I放射性粒子植入序贯治疗。随访时间12-24月，对比序贯治疗前后各项临床指标、影像学的变化，以评价其疗效及安全性。 结果48例患者共接受215次TACE治疗，平均每例患者4.5次，每例患者平均植入粒子数16枚，技术成功率100%，全组未出现治疗相关性死亡，肝内病灶客现缓解率为37.3%（18/48）。瘤栓3个月后影像复查平均回缩3.9mm，完全缓解（CR）15例，部分缓解(PR)25例，稳定（SD）6例,进展（PD）2例，总有效率（CR+PR）为83.3%。门脉主干内径恢复大于80%共41例（85.4%）。1年生存率和2年生存率分别为47.9%，33.33%，中位生存时间为15.8月。48例患者术后3个月患者的肝功能、血常规与术时比较，P=0.028，差异均无统计学意义。 结论TACE联合经皮125I放射性粒子植入序贯治疗原发性肝癌伴门静脉主干癌栓是一种有效安全的方法。

Treatment of liver cancer complicated by MPVTT through TACE combined with percutaneous 125I seed implantation sequential

ObjectiveTo evaluate the clinical therapeutic effect and safety of treatment of liver cancer complicated by main portal vein tumor thrombus (MPVTT) through transcatheter arterial chemoembolization (TACE) combined with percutaneous 125I radioactive seeds implantation sequential. MethodsAmong patients with liver cancer complicated by PVTT who were given interventional therapy at our hospital, 48 of them were diagnosed as liver cancer complicated by MPVTT and given percutaneous 125I radioactive seeds implantation sequential for portal vein tumor thrombus within one week after TACE operation. During the follow-up visit for 12-24 months, the changes of various clinical indicators and iconography before and after sequential therapy were compared to evaluate its therapeutic effect and safety. Results48 Patients have been given totally 215 TACE therapies, 4.5 therapies for each patient in average, and 16 seeds were implanted into each patient in average, with the technical success rate of 100%. The treatment-related death did not occur in the whole group, and the objective remission rate of intrahepatic focal was 37.3% (18/48). The tumor thrombus averagely retracted by 3.9mm in imaging recheck after 3 months. 15 patients were with complete remission (CR), 25 patients with partial remission (PR), 6 patients with stable disease (SD), and 2 patients with progressive disease (PD), and the total remission rate (CR+PR) was 83.3%. 41 patients (85.4%) had portal vein trunk inner diameter recovered for above 80%. The 1-year and 2-year survival rate was respectively 47.9% and 33.33%, and the median survival time was (15.8±3.8) months. Compare the liver function and blood routine test results of 48 patients 3 months after operation with those during operation, P=0.028, and all the differences showed no statistical significance. ConclusionTreatment of liver cancer complicated by main portal vein tumor thrombus (MPVTT) through transarterial chemoembolization (TACE) combined with percutaneous 125I radioactive seeds implantation sequential is safety and effective.