介入治疗原发性肝癌合并门静脉癌栓的疗效分析

摘要

Objective To explore the efficacy of interventional therapy in treatment of patients with primary liver cancer and portal vein tumorous thrombus,and to provide the reference for its clinical treatment. Methods A total of 52 patients with primary liver cancer and tumor thrombi in portal vein were randomly divided into two groups,26 patients in each group. Patients in control group were treated with hepatic artery chemoembolization(TACE),patients in trial group were applied with TACE combined portal vein chemoembolization( PVCE);12 weeks as a course. Results In trial group,the reduction ratio of portal vein diameter,velocity of blood flow,and reduction rate oftumor thrombus were high-er than those of control group,and the difference was statistically significant( P ﹤ 0. 05). Thetotal effective rate of patients in trial group after treatment with combined TACE and PVCE was 80. 77% ,the total effective rate in patients of control group after TACE treatment was 50. 00% , and the efficacy of trial group wassignificantly better than that of control group( P ﹤ 0. 05). Patients in both groups had different degree of vomi-ting,nausea,fever and other adverse reactions during TACE therapy,but there was no significant adverse reaction during the follow - up period for 1 year,the survival rate in trial group was 46. 15% ,and the survival rate in control group was 15. 38% ;hence the survival rate in trial group was significantly higher than that of control group,and the differencewas statistical significant( P ﹤ 0. 05). Conclusion The efficacy of TACE com-bined with PVCE in treatment of patients with primary hepatocellular carcinoma associated with portal vein tumor thrombus is significant,it can markedly raise the survival rate of patients,thus it has important value for clinical application.%目的：探讨介入治疗原发性肝癌合并门静脉癌栓的临床疗效。方法将52例原发性肝癌合并门静脉癌栓患者按照随机数字表法分为两组，每组26例。对照组采用肝动脉化疗栓塞（TACE）方法治疗，治疗组采用 TACE 结合门静脉化疗栓塞（PVCE）治疗。两组治疗均以12周为一个疗程。B 超检测两组患者治疗后门静脉直经、血流速度、癌栓大小变化情况。观察两组患者治疗过程中不良反应发生情况。治疗后随访1年，观察两组患者远期生存率。结果治疗组门静脉直径缩小率、血流速度加快率、癌栓缩小率均显著高于对照组，差异有统计学意义（ P ﹤0.05）。治疗组的总有效率为80.77%，对照组总有效率为50.00%，治疗组治疗效果显著优于对照组（ P ﹤0.05）。两组患者在 TACE 治疗过程中均有不同程度的呕吐、恶心、发热等症状发生，均无明显不良反应发生。随访1年治疗组存活率46.15%；对照组存活率15.38%；治疗组存活率显著高于对照组，差异有统计学意义（ P ﹤0.05）。结论采用 TACE 结合 PVCE 介入治疗原发性肝癌合并门静脉癌栓疗效确切，可明显提高存活率。