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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。
Objective To investigate the feasibility and safety of portal vein radioactive stent implantation combined with drug loaded microspheres via hepatic arterial chemoembolization (DEB-TACE) in the treatment of hepatocellular carcinoma (HCC) with portal vein thrombosis (MPVTT). Methods A prospective, one-arm study of seven patients with confirmed disease was enrolled into the study group. The changes of portal vein pressure before and after portal vein stent implantation were compared. The changes of liver function between preoperative and postoperative 1-3 days, 4-5 days and 5-7 days were compared. Summarize the incidence of complications. Results All the 7 patients were in BCLC-C stage and Child-Pugh A ~ B stage. All were massive liver cancer, 1 case of left liver, 6 cases of right liver, 1 case of portal vein thrombosis of the left branch and 6 cases of right branch tumor thrombus, both of which were associated with MPVTT. All patients were successfully treated with radioactive stent implantation of portal vein DEB-TACE. The average portal venous pressure before and after stent implantation were 15.3 and 10.2 cm H 2 O, respectively, and the pressure dropped significantly. Serum total bilirubin (TB), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased transiently after operation, gradually decreased after 3 ~ 4 days, and the recovery of TB was higher than that of ALT, AST SLOW. 2 patients with myocardial damage, 2 ~ 3 d gradually recovered. Conclusion The combined application of radioactive stent implantation and DEB-TACE in the treatment of HCC combined with MPVTT is safe and feasible, long-term efficacy needs further study.