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目的:评价支架置入联合立体定向放疗治疗肝细胞肝癌致下腔静脉癌栓临床价值。方法:回顾性分析56例原发性肝细胞肝癌伴下腔静脉癌栓患者临床资料,26例单纯支架置入(单纯组),30例支架置入联合立体定向放疗(联合组)。患者均行支架置入,比较手术前、后下腔静脉梗阻段直径;联合组术后行体部伽玛刀治疗下腔静脉癌栓,处方剂量300~400 cGy,等剂量曲线50%~70%覆盖计划靶区,照射总剂量达3 000~4 800 cGy,术后1个月测量下腔静脉梗阻段直径;3,6个月了解下腔静脉通畅情况。结果:2组治疗后1个月下腔静脉直径均有不同程度扩大,单纯组下腔静脉梗阻段直径增加(0.67±0.25)cm,联合组直径增大(1.7±0.21)cm,3,6个月随访单纯支架置入患者下腔静脉通畅率60.87%,21.74%,而支架置入联合立体定向放疗患者为100.00%,2组比较差异有统计学意义(P<0.05)。结论:内支架置入联合立体定向放疗是治疗肝细胞肝癌致下腔静脉癌栓一种安全、有效方法。
Objective: To evaluate the clinical value of stent placement combined with stereotactic radiotherapy in the treatment of hepatocellular carcinoma caused by inferior vena cava tumor thrombus. Methods: The clinical data of 56 patients with hepatocellular carcinoma with tumor thrombus of the inferior vena cava were retrospectively analyzed. Twenty - six patients were treated with simple stent implantation and 30 patients underwent combined stereotactic radiotherapy (combination group). The patients underwent stent implantation. The diameter of the inferior vena cava obstruction before and after surgery was compared. In the combined group, the inferior vena cava tumor thrombus was treated with gamma knife. The prescription dose was 300-400 cGy and the isodose curve was 50-70% % Coverage of the planned target area, the total dose of irradiation of 3 000 ~ 4 800 cGy, 1 month after the measurement of inferior vena cava obstruction diameter; 3,6 months to understand the patency of the inferior vena cava. Results: The diameters of inferior vena cava in 1 month after operation increased to some extents. The diameter of inferior vena cava obstruction in simple group increased (0.67 ± 0.25) cm and the diameter of combined group increased (1.7 ± 0.21) cm, 3,6 The patency rates of inferior vena cava in single-month follow-up stent implantation were 60.87% and 21.74%, respectively. The stent placement was 100.00% in combination with stereotactic radiotherapy. The difference between the two groups was statistically significant (P <0.05). Conclusion: Stent implantation combined with stereotactic radiotherapy is a safe and effective method for treating IVC tumor thrombus caused by hepatocellular carcinoma.