原发性肝癌合并门静脉癌栓的介入治疗进展_医学论文-毕业论文_304.pdf

_- hepatocellular carcinomaHCC 34%~40%90%[1]portal vein tumor thrombusPVTTPVTT PVTT PVTT 1 transcatheter arterial chemo?infusionTAI Sim[2]67HCCPVTT()80mg/m22h4 1(2.5%) 7(17.5%)36HCCPVTT()60mg/m2 2hd25?Fu500mg/m25hd1~341(3.8%) 4(15.4%) 58.55?FuChung[3] 68HCCPVTT4727192mg/kg8 ?α 3.0MU/m250%19127% HCCPVTTPCS Ando[4]48HCCPVTT 7mg/m21hd1~55?Fu 170mg/m25hd1~544CR19PR 48%31.64.1~48.9) 5.41.9~29.0) (P0.001) HCC 2 HCCPVTTtranscatheter arterial chemo?embolizationTACEPVTT TACETACEPVTT PVTT Chung[5]TACE110PVTTTACE31 1123018Yen[6]96HCCPVTT/ 0.51291.451.417.162.326.24.9 10.33.7[7]182PVTT3 (TAI)(Lp?TACE)(LpGs?TACE)3PVTT 7.721.437.7P0.01111.521.433.3P0.053 02.43.6P0.05TACE[8]48HCCPVTT TACE(n=38)(n=10)TACE5.0(4.4~5.6) 2.0(1.8~2.2)(P=0.0000)110.5%0(P=0.066)TACE [9]Katsumori[10]HCCPVTT0.512 674422 TAITACEFukuda[11]19HCC 5?Fu348.5[12]433 12TACE120.00%39.13% P0.05)1 (P0.05)12TACE1 1 TACETACEYamada[13]PVTT60Gy TACE19HCCPVTT57.9%1240.6%10.2%7.0PVTT Tazawa[14]24HCCPVTT50GyTACE4CR8PR8 4CoxChild12Child A73%21% Child BC10%0HCC 3 HCC90%TACE PVTTPVTT PVTTPVTT TACE B [15]472TACE 612243698.9%84.3%46.7%4.2% (P0.01)(P0.05) [16]38PVTTTACEB 76.368.41373.718.4[17]146 PVTT2TACE 130mg5?Fu 5g 340%16.7%(1/6)50%(3/6) 33%(2/6)[18]45HCCPVTT20TACE 25TACEAFP730±190μg/L515±395μg/L 752±183μg/L710±213μg/L(P0.05)/ 65%(13/20)32%(8/25)(P0.05)175%(15/20)48%(12/25) (P0.05) TACEBPVTT [19]111 PVTT7932 12.016.0P0.05135 53.9%26.9%16.6%82.8%48.8%41.3% P0.05 4 PVTT(percutaneous ethanol injectionPEI) PVTT 1~6[20] Yamarnoto[21]50HCCPVTTTACE1~2B 100%/90% 12392.5%57.5%20% [22]HCCPVTT34PEIPVTT 19(A)PEI PVTT 15(B)B 53.3%33.3% 86.6% A( 36.8%36.8% 73.6%)(P0.05)34PVTTAFP2889.2%(25/28)AFP BAFP 75.0%(9/12)A 37.5%(6/16)(P0.05)