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目的探讨经皮、经肝门静脉穿刺激光消融治疗肝癌门静脉癌栓的疗效及其临床意义。方法对肝癌门静脉癌栓患者行经皮经肝门静脉穿刺激光消融治疗,观察患者术后的生存率、癌栓的变化、癌栓支门静脉血流的变化及临床症状、肝功能和腹水等的变化情况。结果93例门静脉癌栓患者行激光消融治疗后6个月、1年和2年的生存率分别为82.8%、53.0%和34.1%。其中11例癌栓部分阻塞者的癌栓截面积在6个月时明显缩小;82例术前癌栓支门静脉完全无血流信号的患者,行激光治疗后第1天均观察剑彩色血流信号。1个月后67例、3个月后57例、6个月后40例、1年后27例、2年后4例患者癌栓部位门静脉支再次观察到彩色血流信号。38例激光消融(LA)治疗后生存1年的患者中,14例癌栓萎缩,直至消失;14例癌栓萎缩,门静脉呈蜂窝状改变;10例癌栓不缩小甚至继续生长,门静脉增宽。接受治疗后,患者临床症状、肝功能和腹水均得到不同程度的改善。结论激光消融治疗肝细胞癌门静脉癌栓,是一种疗效可靠、技术安全的新方法。
Objective To investigate the efficacy and clinical significance of percutaneous transhepatic portal vein puncture laser ablation in the treatment of hepatic cancer with portal vein tumor thrombus. Methods Percutaneous transhepatic portal vein puncture laser ablation was performed in patients with hepatocellular carcinoma and portal vein thrombosis. The changes of survival rate, tumor embolism, changes of portal vein blood flow, clinical symptoms, liver function and ascites were observed. . Results The survival rates of 93 patients with portal vein thrombosis at 6 months, 1 year and 2 years after laser ablation were 82.8%, 53.0% and 34.1%, respectively. Among them, the tumor thrombus cross-sectional area of 11 patients with partial occlusion of thrombus was significantly reduced at 6 months. In 82 patients with complete absence of blood flow signal in the portal vein before the thrombus, the color flow of the sword was observed on the first day after laser treatment signal. 67 cases after 1 month, 57 cases after 3 months, 40 cases after 6 months, 27 cases after 1 year and 4 cases after 2 years again observed the color flow signal in the portal vein branch of the thrombus site. Of the 38 patients who survived 1 year after laser ablation (LA), 14 had atrophy of the tumor until disappearance; 14 had atrophy of the tumor and had a honeycombed portal vein; 10 did not shrink or even grew and the portal vein widened . After treatment, patients with clinical symptoms, liver function and ascites have been improved to varying degrees. Conclusion Laser ablation of portal vein tumor thrombus in hepatocellular carcinoma is a new method with reliable curative effect and safe technique.