原发性肝癌合并门静脉瘤栓的化疗栓塞治疗

将116例合并门静脉主干或左右大分支瘤栓的原发性肝癌分为三组,A组32例,采用单纯肝动脉灌注化疗法;B组66例,采用常规肝动脉化疗加碘油和明胶海绵栓塞法;C组18 例,采用肝段或亚肝段动脉化疗加碘油和明胶海绵栓塞。结果示,A组6、12、18和24个月生存率分别为25 .0%(8/32)、9 .4%(3/32)、3 1%(1/32)和0(0/32),门脉瘤栓消失率为3 .1% (1/32); B 组6、12、18 和24 个月生存率分别为53 .0% (35/66)、25. 8% (17/66)、9 .1%(6/66)和3 0%(2/66),门脉瘤栓消失率为19 .7%(13/66);C组6、12、18 和24 个月生存率分别为72 .2%(13/18)、44 .4%(8/18)、22. 2%(4/18)和11. 1%(2/18),门脉瘤栓消失率为44 .4%(8/18)。各组生存率(P<0 .05)及门脉瘤栓消失率(P<0 .01)差异均有统计学意义。初步观察结果提示,经肝动脉化疗及栓塞法是治疗合并门脉瘤栓原发性肝癌的有效方法,且栓塞法优于单纯灌注化疗法,特别是肝段或亚肝段动脉化疗栓塞法疗效更好。

Chemoembolization for hepatocellular carcinoma with portal vein thrombosis

The objective of this study was to study the clinical effectiveness of arterial chemoembolization for hepatocellular carcinoma with portal vein thrombosis. One hundred and sixteen cases of hepatocellular carcinoma were divided into three growps. Group A (32 cases) were treated with simple chemotherapy, Group B (66 cases) with usual chemoembolization and Group C (18 cases) with segmental or subsegmental arterial chemoembolization. Results: the 6-,12-,18- and 24- month survival rate of Group A were 25.0%(8/32), 9.4%(3/32), 3.1%(1/32) and 0(0/32), respectively. That of Group B were 53.0%(35/66), 25.8%(17/66), 9.1%(6/66) and 3.0%(2/66), respectively. And that of Group C were 72.2%(13/18), 44.4%(8/18), 22.2%(4/18) and 11.1%(2/18), respectively. The disappearance rate of portal vein thrombosis were 3.1%(1/32), 19.7%(13/16) and 44.4%(8/18), respectively. The outcomes were significantly different in the three growps in survival rate, P<0.05, and disapearance rate of portal vein thrombosis, P<0.01. In conclusion, transcatheter hepatic artery chemoembolization is the choice of treating hepatocellular carcinoma with portal vein thrombosis. It is more effevtive than the simple chemotherapy, especially with segmental or subsegmental arterial chemoembolization.