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
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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。
Advances in local ablation therapy for liver cancer with portal hypertension
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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。Abstract: With the comprehensive application of a variety of treatment methods, the survival time of patients with primary liver cancer is gradually increasing. For patients with early-stage liver cancer and portal hypertension, local ablation therapy can achieve long-term survival and play a positive role in stabilizing portal venous pressure, preserving liver function, and reducing complications. In addition, it can be combined with other techniques such as transarterial chemoembolization, transjugular intrahepatic portosystemic shunt, splenectomy, and pericardial devascularization to further improve treatment outcome. Several measures can be taken in the perioperative period to improve the management efficiency of patients after ablation, such as objective evaluation of portal venous pressure, prevention of esophagogastric variceal bleeding, correction of hypersplenism, prevention of postoperative liver failure, and multidisciplinary team management.
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Key words:
- Hepatocellular Carcinoma /
- Hypertension, Portal /
- Catheter Ablation
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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) P值1) 1、3、5年生存率 P值1) 并发症发生率 P值1) 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。 -
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