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目的:研究减量肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)对伴有门脉癌栓肝癌治疗的安全性和疗效。方法:分析复旦大学附属中山医院肝癌研究所行减量TACE治疗伴门脉主干(含一级分支)癌栓的37例原发性肝癌的临床资料。Child A级34例,B级3例。37例共行TACE 75次。结果:37例患者的中位生存期为11．67个月。6个月、12个月和18个月的生存率为75．01％、41．03％和17．61％。门脉癌栓内碘油沉积良好组14例,沉积不良组23例。碘油沉积良好组的中位生存期显著优于沉积不良组为(16．23个月与6．80个月,P<0．05)。碘油沉积良好组的6个月、12个月和18个月的生存率显著高于沉积不良组(分别为100％、63．49％、31．75％和60．29％、13．03％、0％,P<0．05)。多因素分析提示门脉癌栓内碘油沉积情况是唯一的预后因素。Cox回归系数1．67,RR 5．31。术后发生上消化道出血1例,肝功能衰竭症1例, (治疗后2周内死亡),2例治疗后肝功能Child分级增加。结论:减量TACE治疗伴门脉主干癌栓的肝癌是安全有效的。门脉癌栓内碘油沉积良好提示预后好。
Objective: To study the safety and efficacy of transcatheter arterial chemoembolization (TACE) in the treatment of hepatic carcinoma with portal vein thrombosis. Methods: The clinical data of 37 patients with primary hepatocellular carcinoma treated with reduced TACE for the treatment of portal vein thrombosis with primary branches were analyzed in Zhongshan Hospital of Fudan University. Child A class 34 cases, B class 3 cases. 37 cases of TACE total 75 times. Results: The median survival of 37 patients was 11.67 months. Survival rates at 6 months, 12 months and 18 months were 75.01%, 41.03% and 17.61%. Portal vein tumor thrombus in the group of good lipiodol deposition in 14 cases, 23 cases of poor deposition group. The median survival time in the well-preserved group was significantly better than that in the poorly-dysplasia group (P <0.05 for both 16.23 months and 6.80 months). The survival rates at 6, 12 and 18 months in well-preserved lipiodol groups were significantly higher than those in poorly-grouped groups (100%, 63.49%, 31.75% and 60.29%, 13.03, respectively) %, 0%, P <0.05). Multivariate analysis suggested that lipiodol deposition in portal vein tumor thrombus was the only prognostic factor. Cox regression coefficient 1.67, RR 5.31. One case of upper gastrointestinal bleeding and one case of liver failure occurred after operation (within 2 weeks after treatment), and Child classification of liver function increased after 2 cases of treatment. Conclusion: TACE reduction of hepatocellular carcinoma with portal vein thrombosis is safe and effective. Portal vein tumor embolus within a good deposit of lipiodol good prognosis.