PVCE结合TACE治疗原发性肝癌合并门静脉癌栓的临床研究
摘要
目的探讨经皮肝穿刺门静脉化疗栓塞(PVCE)联合肝动脉化疗栓塞(TACE)治疗原发性肝癌(PHC)合并门静脉癌栓(PVTT)的临床价值。
方法对2004年6月～2006年11月不能手术切除的原发性肝癌伴门静脉癌栓的病人48例,进行回顾性分析,其中23例行TACE+PVCE治疗作为研究组,另25例仅行TACE治疗作为对照组,分别比较治疗前后AFP变化、门静脉的变化、胃肠道症状(腹胀、恶心)改善以及1年生存率。
结果1.二组治疗前后AFP的变化:研究组(1569±355)、(1507±320)μg/L,对照组(1334±347)、(1319±104)μg/L,研究组和对照组的AFP在治疗前后均无明显变化(p＞0.05)。2.二组治疗前后门静脉的变化:研究组中:①门静脉直径增宽3例,缩小7例,无变化13例,缩小率为30.4%(7/23),②门静脉血液流速增快7例,变慢4例,无变化12例,增快率为30.4%(7/23),③门静脉癌栓缩小10例,门静脉癌栓缩小率为43.5%(10/23);对照组中:①门静脉直径增宽15例,缩小3例,无变化7例,缩小率为12%(3/25),②门静脉的血液流速增快2例,变慢16例,无变化7例,增快率为8%(2/25),③门静脉癌栓缩小3例,门静脉癌栓缩小率为12%(3/25);研究组中门静脉直径缩小率、门静脉血液流速增快率、癌栓缩小和消失率均明显高于对照组(p＜0.05)。3.二组治疗前后胃肠道症状改善情况:研究组胃肠道症状改善16例,无变化5例,加重2例,胃肠道症状改善率为70%(16/23);而对照组胃肠道症状改善7例,无变化12例,加重6例,胃肠道症状改善率为28%(7/25),研究组中胃肠道症状改善率明显高于对照组(p＜0.05)。4.研究组1年生存率为48(11/23),对照组1年生存率为28%(7/25),研究组1年生存率明显高于对照组(p＜0.05)。二组均未见与治疗相关的严重副作用发生。
结论门静脉化疗栓塞联合肝动脉化疗栓塞治疗原发性肝癌合并门静脉癌栓的疗效肯定,可减轻患者胃肠道症状,改善患者生活质量,对延长患者生存期有一定的疗效。该方法操作简便、安全、可反复实施,是一项可行的治疗方法。
Objective:To investigate the treatment value of precutaneous transhepatic portal vein chemoembolization(PVCE)with transcatheter arterical chemoembolization(TACE)for primary hepatocellular carcinoma with portal vein tumor thrombus.
Methods:From June 2004 to November 2006,48 cases of primary hepatocellular carcinoma with tumor thrombus in the portal vein,were divided into two groups,the treatment group which was treated with TACE+PVCE, and the control group was treated with TACE.The changes of AFP,portal vein,gastrointestinal symptoms(abdominal distention,nausea),and 1-year survival rates were analized respectively.
Results 1.The changes of AFP of before and after treatment in the tow groups The treatment groupwere(1569±355)μg/Land(1507±320)μg/L,the control group were(1334±347)μg/L and(1319±104)μg/L,there was no changes in AFP concentration between the two groups.
2.The changes of the portal vein After treatment,in the treatment group①the portal vein diameter narrowing rate was 30.4%(7/23),②the rate of portal blood flow velocity expidation was 30.4%(7/23),③the reduce rate of PVTT was 43.5%(10/23);In the control group①the portal vein diameter narrowing rate was 12%(3/25),②the rate of portal blood flowvelocity expidation was 8%(2/25),③the reduce rate of PVTT was 12%(3/25).The treatment group in the portal vein diameter narrowing rate, portal blood flow velocity faster,and rate of portal vein tumor thrombus reduce rate were significantly higher(p＜0.05)than the control group.
3.The changes of gastrointestinal symptoms improvement In the treatment group,the rate of gastrointestinal symptoms improvement was 70% (16/23);In the control group,the rate of gastrointestinal symptoms improvement was 28%(7/25).The treatment group in the gastrointestinal symptoms improvement was significantly higher(p＜0.05)than the control group.
4.The changes of the 1-year survival rate After treatment,in the treatment group,the 1-year survival rate was 48%(11/23);in the control group,the 1-year survival rate was 28%(7/25).The changes of the 1-year survival rate of the treatment group was significantly higher(p＜0.05)than control.
Conclusion The treatment of Portal vein embolization chemotherapy with transcatheter arterical chemoembolization for primary hepatocellular carcinoma with portal vein tumor thrombus can reduce the patients gastrointestinal symptomms,improve life quality,extend survival rate.The methods is simple,safe and can be repeated.
方法对2004年6月～2006年11月不能手术切除的原发性肝癌伴门静脉癌栓的病人48例,进行回顾性分析,其中23例行TACE+PVCE治疗作为研究组,另25例仅行TACE治疗作为对照组,分别比较治疗前后AFP变化、门静脉的变化、胃肠道症状(腹胀、恶心)改善以及1年生存率。
结果1.二组治疗前后AFP的变化:研究组(1569±355)、(1507±320)μg/L,对照组(1334±347)、(1319±104)μg/L,研究组和对照组的AFP在治疗前后均无明显变化(p＞0.05)。2.二组治疗前后门静脉的变化:研究组中:①门静脉直径增宽3例,缩小7例,无变化13例,缩小率为30.4%(7/23),②门静脉血液流速增快7例,变慢4例,无变化12例,增快率为30.4%(7/23),③门静脉癌栓缩小10例,门静脉癌栓缩小率为43.5%(10/23);对照组中:①门静脉直径增宽15例,缩小3例,无变化7例,缩小率为12%(3/25),②门静脉的血液流速增快2例,变慢16例,无变化7例,增快率为8%(2/25),③门静脉癌栓缩小3例,门静脉癌栓缩小率为12%(3/25);研究组中门静脉直径缩小率、门静脉血液流速增快率、癌栓缩小和消失率均明显高于对照组(p＜0.05)。3.二组治疗前后胃肠道症状改善情况:研究组胃肠道症状改善16例,无变化5例,加重2例,胃肠道症状改善率为70%(16/23);而对照组胃肠道症状改善7例,无变化12例,加重6例,胃肠道症状改善率为28%(7/25),研究组中胃肠道症状改善率明显高于对照组(p＜0.05)。4.研究组1年生存率为48(11/23),对照组1年生存率为28%(7/25),研究组1年生存率明显高于对照组(p＜0.05)。二组均未见与治疗相关的严重副作用发生。
结论门静脉化疗栓塞联合肝动脉化疗栓塞治疗原发性肝癌合并门静脉癌栓的疗效肯定,可减轻患者胃肠道症状,改善患者生活质量,对延长患者生存期有一定的疗效。该方法操作简便、安全、可反复实施,是一项可行的治疗方法。
Objective:To investigate the treatment value of precutaneous transhepatic portal vein chemoembolization(PVCE)with transcatheter arterical chemoembolization(TACE)for primary hepatocellular carcinoma with portal vein tumor thrombus.
Methods:From June 2004 to November 2006,48 cases of primary hepatocellular carcinoma with tumor thrombus in the portal vein,were divided into two groups,the treatment group which was treated with TACE+PVCE, and the control group was treated with TACE.The changes of AFP,portal vein,gastrointestinal symptoms(abdominal distention,nausea),and 1-year survival rates were analized respectively.
Results 1.The changes of AFP of before and after treatment in the tow groups The treatment groupwere(1569±355)μg/Land(1507±320)μg/L,the control group were(1334±347)μg/L and(1319±104)μg/L,there was no changes in AFP concentration between the two groups.
2.The changes of the portal vein After treatment,in the treatment group①the portal vein diameter narrowing rate was 30.4%(7/23),②the rate of portal blood flow velocity expidation was 30.4%(7/23),③the reduce rate of PVTT was 43.5%(10/23);In the control group①the portal vein diameter narrowing rate was 12%(3/25),②the rate of portal blood flowvelocity expidation was 8%(2/25),③the reduce rate of PVTT was 12%(3/25).The treatment group in the portal vein diameter narrowing rate, portal blood flow velocity faster,and rate of portal vein tumor thrombus reduce rate were significantly higher(p＜0.05)than the control group.
3.The changes of gastrointestinal symptoms improvement In the treatment group,the rate of gastrointestinal symptoms improvement was 70% (16/23);In the control group,the rate of gastrointestinal symptoms improvement was 28%(7/25).The treatment group in the gastrointestinal symptoms improvement was significantly higher(p＜0.05)than the control group.
4.The changes of the 1-year survival rate After treatment,in the treatment group,the 1-year survival rate was 48%(11/23);in the control group,the 1-year survival rate was 28%(7/25).The changes of the 1-year survival rate of the treatment group was significantly higher(p＜0.05)than control.
Conclusion The treatment of Portal vein embolization chemotherapy with transcatheter arterical chemoembolization for primary hepatocellular carcinoma with portal vein tumor thrombus can reduce the patients gastrointestinal symptomms,improve life quality,extend survival rate.The methods is simple,safe and can be repeated.
引文
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2.吴志劝,樊嘉,邱双健,等.门静脉癌栓形成与肝脏供血特性的关系[J].世界华人消化杂志,2004,12(1):243-244.
3.韩国宏,孟祥杰,樊代明,等.肝癌伴门静脉癌栓的诊断与治疗[J].中华消化杂志,2005,25(1):57-59.
4.董磊,刘兰芬,李新民,等.肝癌门静脉癌栓形成原因的探讨[J].中国超声医学杂志,1999,15(6):422-423.
5.薛峰,沈锋,吴孟超.肝癌合并门静脉癌栓的诊治进展[J].中国肿瘤,2005,14(3):148-152.
6.Ikai I,Yamaoka Y,Yamamoto Y,et al.Surgical intervention for patients with stage Iv-A hepatocellular carcinoma without lymph node metastasis:proposal as a standard therapy[J].Ann Surg,1998,227:433-439.
7.樊嘉,吴志全,周俭,等.肝细胞癌伴门静脉癌栓不同治疗方法的比较[J].中华肿瘤杂志,2000,22:247-249.
8.Konishi M,Ryu M,Kinoshita T,et al.Surgical treatment of hepatocelluar carcinoma with direct removal of the tumor thrombus in the main portal ven [J].Hepatogastroenterlogy,2001,48(41):1421-1424.
9.刘崎,田建明,贾雨辰,等.肝癌并门脉主干癌栓的介入治疗及其预后的影响因素[J].中华放射学杂志,1999,33:538-541.
10.李海平,曹觉,王小宣,等.原发性肝癌经动脉化疗栓塞疗效及预后影响因素分析[J].临床放射学杂志,2001,20:66-69.
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