PDF(Pubmed)
Abstract：
BACKGROUND: Hepatic infarction is a rare liver condition. The purpose of this study is to report a case of hepatic infarction caused by thrombus formation following portal vein stent implantation in a patient with hepatocellular carcinoma and portal vein tumor thrombus, and to explore the underlying causes.
METHODS: The patient in this study was a 52-year-old male admitted with diffuse hepatocellular carcinoma involving the right lobe and portal vein tumor thrombus. After undergoing portal vein stent implantation and 125I particle strand implantation treatment, the portal vein was patent, and the pressure decreased. However, multiple instances of hepatic artery chemoembolization combined with targeted immunotherapy resulted in gradual reduction in the diameter of the hepatic artery and affecting hepatic arterial blood flow. Two months post-stent implantation, thrombus formation within the stent was noted, and the patient\'s condition did not improve with anticoagulant therapy, as evidenced by follow-up CT scans showing an increase in thrombi. Six months later, the patient suffered from gastrointestinal bleeding and, despite emergency esophagogastric variceal ligation and hemostatic treatment, developed hepatic parenchymal infarction and liver function failure.
CONCLUSIONS: We reveal the underlying cause is that (1) thrombus formation within the portal vein stent, leading to portal vein embolism and obstructed blood flow due to exacerbate portal hypertension after various treatments; and (2) the effect of hepatic artery chemoembolization, immunotherapy, and targeted therapy on tumor angiogenesis, causing reduced hepatic artery diameter and impaired arterial blood flow. These factors disrupt the liver\'s dual blood supply system, ultimately contributing to hepatic infarction. To our knowledge, this is the first report of hepatic infarction as a complication following portal vein stent implantation for hepatocellular carcinoma with portal vein tumor thrombus, and it holds significant reference value for guiding the treatment of hepatocellular carcinoma with concurrent portal vein tumor thrombus in a clinical setting.
METHODS: The patient in this study was a 52-year-old male admitted with diffuse hepatocellular carcinoma involving the right lobe and portal vein tumor thrombus. After undergoing portal vein stent implantation and 125I particle strand implantation treatment, the portal vein was patent, and the pressure decreased. However, multiple instances of hepatic artery chemoembolization combined with targeted immunotherapy resulted in gradual reduction in the diameter of the hepatic artery and affecting hepatic arterial blood flow. Two months post-stent implantation, thrombus formation within the stent was noted, and the patient\'s condition did not improve with anticoagulant therapy, as evidenced by follow-up CT scans showing an increase in thrombi. Six months later, the patient suffered from gastrointestinal bleeding and, despite emergency esophagogastric variceal ligation and hemostatic treatment, developed hepatic parenchymal infarction and liver function failure.
CONCLUSIONS: We reveal the underlying cause is that (1) thrombus formation within the portal vein stent, leading to portal vein embolism and obstructed blood flow due to exacerbate portal hypertension after various treatments; and (2) the effect of hepatic artery chemoembolization, immunotherapy, and targeted therapy on tumor angiogenesis, causing reduced hepatic artery diameter and impaired arterial blood flow. These factors disrupt the liver\'s dual blood supply system, ultimately contributing to hepatic infarction. To our knowledge, this is the first report of hepatic infarction as a complication following portal vein stent implantation for hepatocellular carcinoma with portal vein tumor thrombus, and it holds significant reference value for guiding the treatment of hepatocellular carcinoma with concurrent portal vein tumor thrombus in a clinical setting.
摘要：
背景：肝梗死是一种罕见的肝脏疾病。本研究的目的是报告一例肝细胞癌和门静脉癌栓患者门静脉支架植入术后血栓形成引起的肝梗塞，并探索根本原因。
方法：本研究中的患者是一名52岁男性，患有累及右叶和门静脉癌栓的弥漫性肝细胞癌。在接受门静脉支架植入和125I粒子链植入治疗后，门静脉是有专利的，压力下降了。然而,多次肝动脉化疗栓塞联合靶向免疫疗法导致肝动脉直径逐渐减小,并影响肝动脉血流.支架植入后两个月,观察到支架内血栓形成,抗凝治疗并没有改善患者的病情，随访CT扫描显示血栓增加。六个月后,病人患有消化道出血，尽管急诊食管胃静脉曲张结扎术和止血治疗，发生肝实质梗死和肝功能衰竭。
结论：我们发现根本原因是（1）门静脉支架内血栓形成，经各种治疗后，门静脉栓塞和血流阻塞加剧门脉高压；（2）肝动脉化疗栓塞的效果，免疫疗法，和肿瘤血管生成的靶向治疗，导致肝动脉直径减小和动脉血流受损。这些因素破坏了肝脏的双重供血系统,最终导致肝梗塞。据我们所知,这是首次报道肝梗死作为门静脉支架植入术治疗肝细胞癌伴门静脉癌栓后的并发症，对指导肝癌合并门静脉癌栓的临床治疗具有重要的参考价值。
方法：本研究中的患者是一名52岁男性，患有累及右叶和门静脉癌栓的弥漫性肝细胞癌。在接受门静脉支架植入和125I粒子链植入治疗后，门静脉是有专利的，压力下降了。然而,多次肝动脉化疗栓塞联合靶向免疫疗法导致肝动脉直径逐渐减小,并影响肝动脉血流.支架植入后两个月,观察到支架内血栓形成,抗凝治疗并没有改善患者的病情，随访CT扫描显示血栓增加。六个月后,病人患有消化道出血，尽管急诊食管胃静脉曲张结扎术和止血治疗，发生肝实质梗死和肝功能衰竭。
结论：我们发现根本原因是（1）门静脉支架内血栓形成，经各种治疗后，门静脉栓塞和血流阻塞加剧门脉高压；（2）肝动脉化疗栓塞的效果，免疫疗法，和肿瘤血管生成的靶向治疗，导致肝动脉直径减小和动脉血流受损。这些因素破坏了肝脏的双重供血系统,最终导致肝梗塞。据我们所知,这是首次报道肝梗死作为门静脉支架植入术治疗肝细胞癌伴门静脉癌栓后的并发症，对指导肝癌合并门静脉癌栓的临床治疗具有重要的参考价值。
