Seo J B, Chung J W, Park J H, Kim S H, Kim T K, Han J K, Choi B I, Han M C
Department of Radiology, Seoul National University College of Medicine, South Korea.
AJR Am J Roentgenol. 1998 Mar;170(3):655-9. doi: 10.2214/ajr.170.3.9490948.
The risk of hepatocellular carcinoma is increased with benign obstruction of the hepatic inferior vena cava (IVC). The purpose of this study was to assess the usefulness of combined interventional treatment for benign obstruction of the hepatic IVC associated with hepatocellular carcinoma.
In a retrospective review of 51 patients with benign obstruction of the hepatic IVC, hepatocellular carcinoma was detected in 15 patients coincidentally or during the follow-up period. Obstruction of the IVC was treated with percutaneous transluminal balloon angioplasty in five patients and metallic stent placement in two patients. Immediate postprocedural and follow-up venacavography was performed to evaluate the effectiveness of this interventional management. Hepatocellular carcinomas were managed with transcatheter chemoembolization in all 15 patients using an emulsion of 3-12 ml of an iodized oil and 20-50 mg of doxorubicin hydrochloride. Gelfoam embolization was performed in three patients. Transcatheter chemoembolizations were repeated in seven patients. Initial response and long-term response to treatment were evaluated by monitoring the level of serum alpha-fetoprotein and by follow-up CT and angiography.
During the follow-up period (1-8 years), the IVC was widely open except in one patient who developed moderate stenosis. Clinical symptoms of vena caval obstruction disappeared in all patients. After initial transcatheter chemoembolization, complete remission of the tumor occurred in six patients and partial remission occurred in seven patients. Five of the seven patients who underwent further chemoembolizations remained unchanged or in remission.
Radiologic interventional treatment plays a significant role in managing both kinds of lesions in patients with benign obstruction of the hepatic IVC complicated by, hepatocellular carcinoma. A follow-up regimen should be designed to detect small hepatocellular carcinoma as early as possible after obstruction of the hepatic IVC is diagnosed.
肝下腔静脉（IVC）良性梗阻会增加肝细胞癌的风险。本研究的目的是评估联合介入治疗对与肝细胞癌相关的肝IVC良性梗阻的有效性。
回顾性分析51例肝IVC良性梗阻患者，其中15例在随访期间或偶然发现合并肝细胞癌。5例患者采用经皮腔内球囊血管成形术治疗IVC梗阻，2例患者置入金属支架。术后即刻及随访行腔静脉造影以评估介入治疗的效果。15例肝细胞癌患者均采用3 - 12 ml碘化油与20 - 50 mg盐酸阿霉素的乳剂行经导管化疗栓塞术。3例患者行明胶海绵栓塞术。7例患者重复行经导管化疗栓塞术。通过监测血清甲胎蛋白水平以及随访CT和血管造影评估治疗的初始反应和长期反应。
在随访期（1 - 8年）内，除1例出现中度狭窄的患者外，IVC均广泛通畅。所有患者腔静脉梗阻的临床症状均消失。初次经导管化疗栓塞术后，6例患者肿瘤完全缓解，7例患者部分缓解。7例接受进一步化疗栓塞术的患者中有5例病情无变化或缓解。
放射介入治疗在肝IVC良性梗阻合并肝细胞癌患者的两种病变治疗中均发挥重要作用。应设计随访方案以便在诊断肝IVC梗阻后尽早发现小肝细胞癌。
