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肝癌合并门静脉高压的局部消融治疗

罗文 帖君

罗文, 帖君. 肝癌合并门静脉高压的局部消融治疗[J]. 临床肝胆病杂志, 2021, 37(3): 515-521. DOI: 10.3969/j.issn.1001-5256.2021.03.005
引用本文: 罗文, 帖君. 肝癌合并门静脉高压的局部消融治疗[J]. 临床肝胆病杂志, 2021, 37(3): 515-521. DOI: 10.3969/j.issn.1001-5256.2021.03.005
LUO W, TIE J. Advances in local ablation therapy for liver cancer with portal hypertension[J]. J Clin Hepatol, 2021, 37(3): 515-521. DOI: 10.3969/j.issn.1001-5256.2021.03.005
Citation: LUO W, TIE J. Advances in local ablation therapy for liver cancer with portal hypertension[J]. J Clin Hepatol, 2021, 37(3): 515-521. DOI: 10.3969/j.issn.1001-5256.2021.03.005

肝癌合并门静脉高压的局部消融治疗

DOI: 10.3969/j.issn.1001-5256.2021.03.005
详细信息
    作者简介:

    罗文(1982—),女,副教授,博士,主要从事肝肿瘤超声造影诊断及超声引导下消融治疗

    通讯作者:

    帖君,tiejun7776@163.com

  • 利益冲突声明:所有作者均声明不存在利益冲突。
  • 作者贡献声明:罗文负责文献检索、撰写及修改论文;帖君负责拟定写作思路,指导撰写及修改论文,并最后定稿。
  • 中图分类号: R735.7

Advances in local ablation therapy for liver cancer with portal hypertension

  • 摘要: 随着多种治疗方法的综合应用,原发性肝癌患者生存期不断延长。对于合并门静脉高压的早期肝癌患者,局部消融治疗可达到长期生存,并在稳定门静脉压力,保存肝脏功能,减少并发症等方面具有积极的作用。此外,局部消融可以和经肝动脉化疗栓塞术、经颈内静脉肝内门体分流术、脾切除、贲门周围血管离断术等方法相结合,进一步提高疗效。围手术期客观评价门静脉压力,预防食管胃底静脉曲张破裂出血,纠正脾功能亢进和防止术后肝衰竭,做好多学科团队协作管理,有助于提升消融后患者的管理效率。
  • 表  1  肝切除术和局部消融治疗合并门静脉高压的HCC患者效果比较

    第一作者及文献 年份 治疗方法 例数 肿瘤大小(cm) P1) 1、3、5年生存率 P1) 并发症发生率 P1)
    Xiao[8] 2015 肝切除术 58 80.4%、55.6%、28.1% 32.8%;1例因术后出血及肝衰竭死亡
    TACE/热消融 42 60.7%、24.4%、7.3% <0.001 26.2%;无死亡病例 >0.05
    Qiu[11] 2015 肝切除术 123 3.1±1.1 96.5%、74.9%、57.0% Clavien-Dindo分级
    Grade1~2:59.3%
    Grade3~5:6.5%
    热消融 57(微波),79(射频) 2.9±1.1 <0.05 91.8%、56.7%、41.1 % 0.01 Grade1~2:27.2%
    Grade3~5:2.2%
    <0.05
    Harada[12] 2016 肝切除术 20 2.1 (0.7~5)2) 100%、91%、91% Clavien-Dindo分级
    Grade1~2:30.9%
    Grade3~5:16.1%
    热消融 20(射频) 1.4 (0.7~2.4)2) <0.05 100%、91%、60% >0.05 Grade1~2:10%
    Grade3~5:2.5%
    <0.05
    Karabulut[13] 2012 肝切除术 923) 5.3(1.5~18)2) 5年:40% 32%
    热消融 92(射频)3) 3.1(1~7)2) <0.05 5年:21% <0.05 3% <0.05
    邹浩[14] 2018 肝切除 61 88.1%、64.1%、40.3%4)
    热消融 93 84.9%、52.8%、43.4%4) >0.05
    王鹤霖[15] 2017 肝切除 41 3.6±1.7 95%、74% 58.5%;Clavien-Dindo分级Ⅲ以上:7.3%
    热消融 48(微波) 2.40±0.95 <0.05 94%、80% >0.05 64.6%;Clavien-Dindo分级Ⅲ以上:0 >0.05
    注:1)消融组与肝切除组比较;2)中位数(范围);3)肝切除术组不合并门静脉高压,腹腔镜射频消融组中患者合并门静脉高压;4)1、3、5年无瘤生存率。
    下载: 导出CSV
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  • 收稿日期:  2020-12-08
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