TACE联合门静脉支架置放术治疗原发性肝癌合并门静脉癌栓的疗效
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摘要
目的分析肝动脉化疗栓塞(TACE)联合门静脉支架置放术治疗原发性肝癌合并门静脉癌栓(PVTT)的疗效及安全性.方法回顾性分析原发性肝癌合并PVTT患者74例,其中35例行单纯TACE治疗(TACE组),39例行TACE联合门静脉支架置放术(联合组),比较两组治疗后肝功能、肝癌活性指标,应用Kaplan-Meier法进行生存分析,并观察两组不良反应.结果治疗后8周,联合组血清谷丙转氨酶(ACT)、谷草转氨酶(AST)、直接胆红素(DBIL)、总胆红素(TBIL)及甲胎蛋白异质体(AFP-L3)、E钙粘连蛋白(EC)、血管内皮生长因子(ICAM-1)、细胞间黏附分子水平均明显低于TACE组(P<0.05).联合组中位生存时间为6.7个月,明显长于TACE组的4.4个月(P<0.05);联合组1 a生存率为10.26%,明显高于TACE组的0.00%(P<0.05).两组均无手术相关性死亡及严重并发症发生,且治疗后主要不良反应发生率比较差异无统计学意义(P>0.05).结论 TACE联合门静脉支架置放术治疗原发性肝癌合并PVTT可有效延长患者生存期,且安全性较好.
Objective To analyze the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with portal vein stent in the treatment of primary liver cancer with portal vein tumor thrombus(PVTT).Method 74 patients with primary liver cancer complicated with PVTT were retrospectively analyzed,35 patients was treated with TACE alone(TACE group),39 patients was treated with TACE combined with portal vein stent placement(combined group). The liver function and liver cancer activity indexes of the two groups after treatment were compared,the survival analysis was performed by Kaplan-Meier method,the adverse reactions of the two groups were observed. Results At 8 th week after treatment,the levels of serum alanine aminotransferase(ACT),glutamic oxalacetic transaminase(AST),direct bilirubin(DBIL),total bilirubin(TBIL),alpha-fetoprotein heterogene(AFP-L3),E-cadherin(Ec),vascular endothelial growth factor(VESF)and intercellular adhesion molecule(ICAM-1) of the combined group were significantly lower than those of the TACE group(P < 0. 05). The median survival time was 6. 7 months in the combined group,significantly longer than 4.4 months in TACE group(P < 0. 05). The 1-year survival rate was 10. 26% in the combined group,significantly higher than 0. 00% in TACE group(P < 0. 05). There were no surgical-related deaths and serious complications in the two groups,there was no significant difference in the incidence of major adverse reactions after treatment(P> 0.05).Conclusion TACE combined with portal vein placement for the treatment of primary liver cancer with PVTT can effectively prolong the survival of patients,and the safety is good.
Objective To analyze the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with portal vein stent in the treatment of primary liver cancer with portal vein tumor thrombus(PVTT).Method 74 patients with primary liver cancer complicated with PVTT were retrospectively analyzed,35 patients was treated with TACE alone(TACE group),39 patients was treated with TACE combined with portal vein stent placement(combined group). The liver function and liver cancer activity indexes of the two groups after treatment were compared,the survival analysis was performed by Kaplan-Meier method,the adverse reactions of the two groups were observed. Results At 8 th week after treatment,the levels of serum alanine aminotransferase(ACT),glutamic oxalacetic transaminase(AST),direct bilirubin(DBIL),total bilirubin(TBIL),alpha-fetoprotein heterogene(AFP-L3),E-cadherin(Ec),vascular endothelial growth factor(VESF)and intercellular adhesion molecule(ICAM-1) of the combined group were significantly lower than those of the TACE group(P < 0. 05). The median survival time was 6. 7 months in the combined group,significantly longer than 4.4 months in TACE group(P < 0. 05). The 1-year survival rate was 10. 26% in the combined group,significantly higher than 0. 00% in TACE group(P < 0. 05). There were no surgical-related deaths and serious complications in the two groups,there was no significant difference in the incidence of major adverse reactions after treatment(P> 0.05).Conclusion TACE combined with portal vein placement for the treatment of primary liver cancer with PVTT can effectively prolong the survival of patients,and the safety is good.
引文
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[6]刘开才,吕维富,周春泽,等.TACE治疗原发性肝细胞癌合并门静脉癌栓疗效及影响因素[J].中国介入影像与治疗学,2018,15(6):331-336.
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[8] Kojima H,Hatano E,Taura K,et al.Hepatic resection for hepatocellular carcinoma with tumor thrombus in the major portal vein[J]. Digestive Surgery,2015,32(6):413-420.
[9]敖劲,曾令雯,刘衡,等.原发性肝癌DSA表现与TACE疗效的关系分析[J].中国普通外科杂志,2016,25(1):51-56.
[10]徐恩君,陈秋莉,李涛,等.血清AFP、AFP-L3联合检测在原发性肝癌中的诊断价值[J].安徽医科大学学报,2016,51(7):1066-1070.
[11]朱理辉,罗勇,廖文秋,等.MicroRNA-219-5p靶向E-钙黏蛋白调控上皮间质转化抑制肝癌细胞侵袭转移[J].中国现代医学杂志,2016,26(18):22-29.
[12]宋威,马亦龙,赵昌,等.TACE联合放射性125I粒子植入治疗原发性肝癌合并门静脉癌栓[J].中国介入影像与治疗学,2016,13(9):526-529.
[2] Lee J M,Jang B K,Lee Y J,et al.Survival outcomes of hepatic resection compared with transarterial chemoembolization or sorafenib for hepatocellular carcinoma with portal vein tumor thrombosis[J]. Clinical&Molecular Hepatology,2016,22(1):160-167.
[3]李文会,戴真煜,万豪光,等.125I粒子条联合门静脉支架及TACE序贯索拉非尼治疗肝癌合并门静脉主干癌栓[J].中华医学杂志,2016,96(23):1838-1842.
[4]蒋丽,韩东明,胡鸿涛,等.125I粒子植入联合肝动脉化疗栓塞术预防原发性肝癌合并门静脉癌栓消化道出血[J].中华放射学杂志,2016,50(10):784-788.
[5]李威,杨学刚,许国辉,等.肝动脉化疗栓塞联合重组人血管内皮抑制素治疗原发性肝癌合并门静脉癌栓的临床疗效分析[J].中华肝脏病杂志,2017,25(3):226-228.
[6]刘开才,吕维富,周春泽,等.TACE治疗原发性肝细胞癌合并门静脉癌栓疗效及影响因素[J].中国介入影像与治疗学,2018,15(6):331-336.
[7]单长胜,王松,于春鹏,等.门静脉支架同步125I粒子条植入联合经导管动脉化疗栓塞术治疗肝癌伴门静脉癌栓[J].中国医学影像技术,2015,31(3):429-433.
[8] Kojima H,Hatano E,Taura K,et al.Hepatic resection for hepatocellular carcinoma with tumor thrombus in the major portal vein[J]. Digestive Surgery,2015,32(6):413-420.
[9]敖劲,曾令雯,刘衡,等.原发性肝癌DSA表现与TACE疗效的关系分析[J].中国普通外科杂志,2016,25(1):51-56.
[10]徐恩君,陈秋莉,李涛,等.血清AFP、AFP-L3联合检测在原发性肝癌中的诊断价值[J].安徽医科大学学报,2016,51(7):1066-1070.
[11]朱理辉,罗勇,廖文秋,等.MicroRNA-219-5p靶向E-钙黏蛋白调控上皮间质转化抑制肝癌细胞侵袭转移[J].中国现代医学杂志,2016,26(18):22-29.
[12]宋威,马亦龙,赵昌,等.TACE联合放射性125I粒子植入治疗原发性肝癌合并门静脉癌栓[J].中国介入影像与治疗学,2016,13(9):526-529.