门脉粒子支架联合载药微球栓塞治疗肝癌7例

发布时间：2018-06-14 11:36

本文选题：肝细胞肝癌 + 门静脉支架　；参考：《介入放射学杂志》2017年02期

【摘要】：目的探讨门静脉放射性粒子支架植入联合载药微球经肝动脉化学栓塞术(DEB-TACE)治疗肝细胞肝癌(HCC)伴门静脉主干癌栓(MPVTT)的可行性和安全性。方法前瞻性单臂研究,7例确诊患者顺序入组接受治疗,比较门静脉支架植入前后门静脉压力变化,术前和术后1~3 d、4 d和5~7 d肝功能变化的差异,总结并发症发生情况。结果 7例患者均为BCLC-C期,Child-Pugh A~B级。均为巨块型肝癌,左肝1例,右肝6例,门静脉左支癌栓1例,右支癌栓6例,均伴有MPVTT。所有患者均顺利进行放射性粒子支架门静脉内植入联合DEB-TACE治疗。支架植入前后门静脉平均压力分别为15.3和10.2 cm H_2O,压力下降明显。血清总胆红素(TB)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)术后一过性增高,3~4 d后逐渐下降,TB恢复较ALT、AST慢。2例患者伴心肌损害,2~3 d后逐渐恢复。结论联合应用放射性粒子支架门静脉内植入和DEB-TACE治疗HCC合并MPVTT是安全可行的,远期疗效需进一步研究。
[Abstract]:Objective to investigate the feasibility and safety of portal vein radioactive particle stent implantation combined with drug-loaded microsphere transcatheter arterial chemoembolization (DEB-TACE-DEB-TACE) in the treatment of hepatocellular carcinoma (HCC) with portal vein thrombus (MPVTT). Methods Seven patients with unilateral prospective single-arm study received sequential treatment. The changes of portal vein pressure before and after portal vein stent implantation, the difference of hepatic function before and after 1 day 3 days and 5 days after operation were compared, and the occurrence of complications was summarized. Results all of the 7 patients were of Child-Pugh Agna B grade in BCLC-C stage. All patients were giant liver cancer, left liver in 1 case, right liver in 6 cases, left portal vein tumor thrombus in 1 case, right branch tumor thrombus in 6 cases, all with MPVTT. All patients were successfully treated with radioactive seed stent implantation in portal vein combined with DEB-TACE. The mean portal vein pressure before and after stent implantation was 15.3 cm and 10.2 cm H _ 2O, respectively. Serum total bilirubin (TBN), alanine aminotransferase (alt) and aspartate aminotransferase (AST) were temporarily increased 3 days after operation. Conclusion it is safe and feasible to use radioactive particle stent in portal vein implantation and DEB-TACE in the treatment of HCC with MPVTT, and the long-term effect needs further study.
【作者单位】：上海交通大学医学院附属瑞金医院放射介入科;
【分类号】：R735.7

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