腔内导管射频消融联合TACE治疗原发性肝细胞癌门静脉癌栓的疗效观察

摘要

目的 评价采用HabibTM VesOpen血管内射频消融导管行经皮穿刺射频消融联合TACE治疗原发性肝细胞癌门静脉癌栓的疗效和安全性.方法 选择原发性肝细胞癌合并门静脉主干或主要分支内癌栓患者39例,采用HabibTMVesOpen腔内导管射频消融联合TACE治疗,评价手术成功率、术后并发症、血液指标、甲胎蛋白、门静脉通畅及癌栓的影像学变化情况.结果 39例患者手术均顺利完成,未发生血管穿孔、感染、肝脓肿、腹腔出血等与手术相关的并发症;术后2周、4周血常规(白细胞、红细胞、血小板计数)与术前比较差异无统计学意义(P均＞0.05);肝功能除总胆红素外,丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、血清白蛋白手术前后比较差异有统计学意义(P均＜0.05);甲胎蛋白手术前后比较差异有统计学意义(P＜0.05).术后4周多普勒超声检查提示原堵塞门静脉均有血流通过;术后8周行上腹部增强CT检查或MR检查,提示患者癌栓有不同程度变小或消失.结论 采用HabibTM VesOpen血管内射频消融导管经皮穿刺门静脉内癌栓射频消融具有可行性,有望成为治疗原发性肝细胞癌门静脉癌栓的有效手段.%Objective To cvaluate the efficacy and safety of HabibTM VesOpen intravascular radiofrequency catheter percutaneous radiofrequency ablation combined with TACE in the treatment of portal vein tumor thrombus of primary hepatocellular carcinoma.Methods Thirty-nine patients with primary hepatocellular carcinoma complicated with portal vein thrombosis were treated with HabibTM VesOpen intracavitary catheter ablation combined with TACE.The postoperative success rate,complication,blood index,α-fetoprotein (AFP),portal vein patency and tumor thrombus imaging changes were assessed.Results All of 39 patients underwent surgery successfully without occurrence of perforation,infection,hepatapostema,intra-abdominal hemorrhage nor other complications associated with surgery.Blood routine examinations (WBC,RBC,PLT) after 2 weeks and 4 weeks of surgery had no statistical difference compared with those of preoperation.Liver function indexes including ALT,AST,ALB had statistical difference before and after the surgery except for TBIL.AFP had statistical difference before and after surgery.Doppler ultrasonography after 4 weeks showed blood flow in original blocked portal vein.Enhanced CT or MR examinations after 8 weeks on the abdomen,suggested that tumors were shrinked or disappeared.Conclusion Radiofrequency catheter ablation with intracavitary radiofrequency catheter of HabibTM VesOpen is an effective method in the treatment of portal vein tumor thrombus in primary hepatocellular carcinoma.