双导向技术引导下125I粒子条联合门静脉支架植入术序贯经导管动脉化疗栓塞术治疗原发性肝细胞癌合并门静脉癌栓的有效性及安全性

摘要/Abstract

摘要： 目的：评价双导向技术引导下¹²⁵I粒子条联合门静脉支架植入术序贯经导管动脉化疗栓塞术（transcatheter arterial chemoembolization,TACE）治疗原发性肝细胞癌（hepatocellular carcinoma,HCC）合并门静脉癌栓（portal vein tumor thrombus,PVTT）的有效性及安全性。
方法：回顾性分析2016年7月至2018年7月湖南省人民医院收治的140例原发性HCC合并PVTT患者的临床资料,其中60例患者采用超声及数字减影血管造影术（digital subtraction angiography,DSA）双导向技术引导下¹²⁵I粒子条联合门静脉支架植入术序贯TACE治疗（联合治疗组）,80例患者采用单纯TACE治疗（单纯治疗组）。观察并比较两组患者的近期疗效和生存情况,以及手术前后癌栓大小、肝功能指标和凝血酶原时间（prothrombin time,PT）。
结果：①术后30d,联合治疗组患者治疗缓解率为80.0%,总有效率为96.7%,单纯治疗组患者治疗缓解率为58.8%,总有效率为85.0%;联合治疗组患者治疗缓解率和总有效率均高于单纯治疗组患者,且差异均有统计学意义（P均<0.05）。②术后两组患者癌栓面积均较术前缩小,术后联合治疗组患者癌栓面积小于单纯治疗组患者,且差异均有统计学意义（P均<0.05）。③术后7d两组患者谷丙转氨酶（glutamic-pyruvic transaminase,GPT）、谷草转氨酶（glutamic-oxaloacetic transaminase,GOT）、总胆红素（total bilirubin,TBIL）水平均较术前升高,而术后30d均较术后7d下降,且差异均有统计学意义（P均<0.05）。联合治疗组患者术后7d GPT、GOT、TBIL水平均高于单纯治疗组,术后30d则均低于单纯治疗组,且差异均有统计学意义（P均<0.05）。④联合治疗组患者术后3年总生存率为51.7%,单纯治疗组患者术后3年总生存率为23.8%,联合治疗组患者术后3年生存率低于单纯治疗组,且差异有统计学意义（P<0.05）。
结论：双导向技术引导下¹²⁵I粒子条联合门静脉支架植入术序贯TACE治疗HCC合并PVTT的近期疗效较好,优于单纯应用TACE的疗效,明显提高患者3年内生存率,但治疗过程中需预防和治疗其引起的肝功能损伤。

关键词: 双导向技术, ¹²⁵I粒子条, 门静脉支架植入术, 经导管动脉化疗栓塞术, 原发性肝癌, 肝细胞癌, 门静脉癌栓

Abstract: Objective:To study and observe the efficacy and safety of sequential transcatheter arterial chemoembolization (TACE) with ¹²⁵I seed bar combined with portal vein stent implantation under the guidance of double guidance technology in the treatment of primary hepatocellular carcinoma (HCC) complicated with portal vein tumor thrombus (PVTT).
Method:The clinical data of 140 HCC patients with PVTT treated in Hunan Provincial People's Hospital from July 2016 to July 2018 were retrospectively analyzed. According to the treatment methods, they were divided into 60 cases in the combined group (¹²⁵I particle strip combined with portal vein stent implantation sequential TACE treatment under the guidance of double guidance technology) and 80 cases in the simple group (TACE treatment alone). The short-term efficacy and survival of the two groups, the changes of tumor thrombus size before and after treatment were observed and compared changes of liver function and laboratory indexes.
Result:①Thirty days after operation, the remission rate of the combined group was 80.0%, and the total effective rate was 96.7%. The remission rate of the simple group was 58.8%, and the total effective rate was 85.0%. The remission rate and total effective rate of the combined group were significantly higher than those of the simple group (P<0.05). ②The area of tumor thrombus after operation was significantly smaller than that before operation in both groups (P<0.05); The area of postoperative tumor thrombus in the combined group was significantly smaller than that in the simple group (P<0.05). ③ The levels of glutamic-pyruvic transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), total bilirubin (TBIL) in the two groups were significantly higher 7 days after operation than those before operation, and were significantly lower than those 30 days after operation. The analysis of variance within the two groups was statistically significant (P<0.05). The levels of GPT, GOT and TBIL in the combined group were significantly higher than those in the simple group 7 days after operation, and the levels of GPT, GOT and TBIL in the combined group 30 days after operation were significantly lower than those in the simple group, with statistical significance (P<0.05). ④The 3-year overall survival rate was 51.7% in the combined group and 23.8% in the simple group. The survival outcome of the combined group was significantly better than that of the simple group (P<0.05).
Conclusion:The short-term effect of sequential TACE guided by double guidance technology with ¹²⁵I particle strip combined with portal vein stent implantation in the treatment of HCC complicated with PVTT is better than that of TACE alone, which significantly increases the survival rate within 3 years, but the liver function injury caused by TACE should be prevented and treated in the process of treatment.

Key words: Double guidance technology, ¹²⁵I seed strip, Portal vein stent, Transcatheter arterial chemoembolization, Primary liver cancer, Hepatocellular carcinoma, Portal vein tumor thrombus

周腾超, 田壮博龙林. 双导向技术引导下¹²⁵I粒子条联合门静脉支架植入术序贯经导管动脉化疗栓塞术治疗原发性肝细胞癌合并门静脉癌栓的有效性及安全性[J]. 肝癌电子杂志, 2022, 9(4): 52-58.

Zhou Tengchao^*, Tian Zhuangbo, Long Lin. Efficacy and safety of sequential transcatheter arterial chemoembolization with ¹²⁵I seed strip combined with portal vein stent implantation guided by double guidance technology in the treatment of primary hepatocellular carcinoma complicated with portal vein tumor thrombus[J]. Electronic Journal of Liver Tumor, 2022, 9(4): 52-58.

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双导向技术引导下¹²⁵I粒子条联合门静脉支架植入术序贯经导管动脉化疗栓塞术治疗原发性肝细胞癌合并门静脉癌栓的有效性及安全性

Efficacy and safety of sequential transcatheter arterial chemoembolization with ¹²⁵I seed strip combined with portal vein stent implantation guided by double guidance technology in the treatment of primary hepatocellular carcinoma complicated with portal vein tumor thrombus

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