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目的:评价肝脏肿瘤引起的下腔静脉恶性梗阻腔内支架介入治疗的疗效。方法:对126例下腔静脉恶性梗阻患者采用Z形自膨式金属内支架治疗,其中原发性肝癌102例,转移性肝癌24例。术前对患者行CT或MRI检查了解下腔静脉梗阻情况并记录患者临床梗阻症状。放置支架前后分别行下腔静脉造影。对下腔静脉狭窄或闭塞段长度、直径、压差进行分析。术后每2个月行下腔静脉造影或CT检查随访支架通畅情况。结果;126例患者置入145个支架。下腔静脉狭窄或闭塞长度为6．3±2．1 cm,狭窄段压力差由2．1±0．5 kPa降为0．5±0．12 kPa。狭窄段直径由0．3±0．11 cm扩张至 1．5±0．4 cm。术后患者症状迅速改善,未见严重并发症发生。随访2～24个月,支架通畅率为87．2％。结论:置放Z形自膨式金属内支架,是对肝脏肿瘤引起的下腔静脉恶性梗阻行姑息性治疗的一种有效方法。
Objective: To evaluate the efficacy of interventional treatment of malignant inferior vena cava obstruction caused by liver tumor. Methods: Twenty-six patients with malignant inferior vena cava obstruction were treated with Z-shaped self-expandable metal stents, including 102 cases of primary liver cancer and 24 cases of metastatic liver cancer. Patients underwent preoperative CT or MRI to understand the situation of inferior vena cava obstruction and record the clinical symptoms of patients with obstruction. Before and after stent placement were performed inferior vena cava angiography. The length, diameter and pressure difference of the inferior vena cava stenosis or occlusion segment were analyzed. Follow-up stent patency was performed with inferior vena cava angiography or CT every 2 months after operation. Results; 126 patients were placed in 145 stents. The length of inferior vena cava stenosis or occlusion was 6.3 ± 2.1 cm, and the pressure difference in the stenosis decreased from 2.1 ± 0.5 kPa to 0.5 ± 0.12 kPa. The diameter of the stenosis expanded from 0.3 ± 0.11 cm to 1.5 ± 0.4 cm. Postoperative symptoms of patients improved rapidly, no serious complications occurred. Follow-up 2 to 24 months, stent patency rate was 87.2%. Conclusion: Placement of Z-shaped self-expandable metal stent is an effective method for palliative treatment of malignant obstruction of inferior vena cava caused by liver tumor.