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本文对46例有门/静脉主干或一级分支受侵犯的肝癌的血管造影表现、治疗方法及疗效进行了分析.门脉内有瘤栓者44例,有动门脉短路(APS)者23例,有动静脉短路(AVS)7例.31例作了THAI+THAE,15例单纯作了THAI.栓塞组平均生存9.6个月.中位生存8个月.单纯化疗组,平均生存5.8个月,中位生存4.5个月。根据影像特点、治疗情况并结合文献,讨论认为:(1)肝癌易侵犯门静脉,与肝癌多发生在肝硬化的基础上有关;(2)肝癌侵犯门静脉较侵犯肝静脉检出率高,静脉内瘤栓的形状不同与检查方法有关;(3)静脉主支受侵犯时,THAE 不属禁忌,用THAE 并THAI 较单纯THAI 疗效好.
This article analyzed the angiographic appearance, treatment and efficacy of 46 cases of hepatocellular carcinoma with portal/venous trunk or primary branch invasion. There were 44 cases of tumor thrombus in the portal vein and 23 cases of active portal vein short-circuit (APS). Cases, there are arteriovenous short circuit (AVS) in 7 cases. 31 cases were made THAI + THAE, 15 cases were simply made THAI. The average survival of the embolization group 9.6 months. The median survival of 8 months. The chemotherapy alone group, the average survival of 5.8 Month, median survival 4.5 months. According to the characteristics of the image, the treatment situation and the literature, it is discussed that: (1) liver cancer is easy to invade the portal vein, and it is related to the occurrence of hepatocellular carcinoma on the basis of cirrhosis; (2) the detection rate of portal vein invasion of hepatocellular carcinoma is higher than that of invading hepatic vein. The shape of the tumor thrombus was different from the examination method; (3) THAE was not contraindicated when the main vein was invaded. The effect of THAE and THAI was better than that of THAI alone.