Stanford A 型胸主動脈夾層術后殘留多發腹腔動脈慢性夾層合并肝癌 1 例報道及文獻復習_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

黎萬華 , 肖靜 , 楊宇恒 , 周蓉 ,  李慶東

重慶大學附屬腫瘤醫院血管與介入科（重慶 400030）;

Corresponding?author：

李慶東, Email: 1515607901@qq.com

Keywords：

主動脈夾層; 肝細胞癌; 肝動脈化療栓塞; 靶向治療; 免疫治療

DOI：

10.7507/1007-9424.202605063

Video：

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目的探討Stanford A 型胸主動脈夾層術后殘留多發腹腔動脈慢性夾層合并肝癌患者的個體化綜合治療策略，并評估肝動脈化療栓塞聯合靶向、免疫治療在治療此類患者中的療效與安全性。方法回顧性分析重慶大學附屬腫瘤醫院收治的1例Stanford A 型胸主動脈夾層術后殘留多發腹腔動脈慢性夾層合并肝癌患者的臨床資料，并對已發表的關于動脈夾層合并肝癌的報道進行文獻回顧。結果對患者進行 3 次肝動脈化療栓塞聯合靶向和免疫治療，同時配合降壓、抗病毒治療。經過24 個月隨訪，患者腫瘤標志物恢復正常，肝腫瘤病灶縮小；腹腔動脈慢性夾層病情穩定，無夾層破裂、腹腔臟器灌注不良等嚴重血管并發癥，血壓控制滿意。檢索肝癌合并主動脈夾層相關報道，最終納入個案報道5篇。既往報道病例的共同臨床特征為肝癌患者接受靶向藥物治療后繼發主動脈夾層。結論本例資料示肝動脈化療栓塞聯合靶向和免疫治療可有效治療合并多發腹腔動脈慢性夾層的肝癌患者，提示該綜合方案在此類特殊人群中具備臨床應用價值。

Citation： 黎萬華, 肖靜, 楊宇恒, 周蓉, 李慶東. Stanford A 型胸主動脈夾層術后殘留多發腹腔動脈慢性夾層合并肝癌 1 例報道及文獻復習. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2026, 33(8): 1105-1109. doi: 10.7507/1007-9424.202605063 Copy

1.	Hwang SY, Danpanichkul P, Agopian V, et al. Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment [J/OL]. Clin Mol Hepatol, 2025, 31(Suppl): S228-S254. doi: 10.3350/cmh.2024.0824.
2.	Chan YT, Zhang C, Wu J, et al. Biomarkers for diagnosis and therapeutic options in hepatocellular carcinoma [J/OL]. Mol Cancer, 2024, 23(1): 189. doi: 10.1186/s12943-024-02101-z.
3.	Jiang M, Chen C, Hu Y, et al. Locoregional therapy combined with targeted therapy and immunotherapy for hepatocellular carcinoma with portal vein tumor thrombosis: a systematic review and meta-analysis [J/OL]. Sci Rep, 2025, 15(1): 39494. doi: 10.1038/s41598-025-23027-6.
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6.	Tsuchiya A, Ogawa M, Watanabe Y, et al. Successful treatment of aortic dissection during sorafenib therapy for hepatocellular carcinoma [J]. Clin Case Rep, 2018, 6(8): 1643-1644.
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9.	Wu JJ, Hsu YC. Acute type A aortic dissection during vascular endothelial growth factor tyrosine kinase inhibitor lenvatinib therapy [J/OL]. Case Rep Crit Care, 2025, 2025: 3082479. doi: 10.1155/crcc/3082479.
10.	中華人民共和國國家衛生健康委員會醫政司. 原發性肝癌診療指南(2026年版) [J]. 中國普外基礎與臨床雜志, 2026, 33(4): 425-485.
11.	周旻, 符偉國. Stanford B型主動脈夾層診斷和治療中國專家共識(2022版) [J]. 中國血管外科雜志(電子版), 2022, 14(2): 119-130.
12.	Carrel T, Sundt TM, von Kodolitsch Y, et al. Acute aortic dissection [J]. Lancet, 2023, 401(10378): 773-788.
13.	Dai S, Zhong Y, Cui H, et al. Aortic dissection induced by vascular endothelial growth factor inhibitors [J/OL]. Front Pharmacol, 2023, 14: 1189910. doi: 10.3389/fphar.2023.1189910.
14.	Cheng C, Nguyen MN, Nayernama A, et al. Arterial aneurysm and dissection with systemic vascular endothelial growth factor inhibitors: a review of cases reported to the FDA adverse event reporting system and published in the literature [J]. Vasc Med, 2021, 26(5): 526-534.
15.	Kitada Y, Okamura H, Hasui H, et al. Morphologic prognostic factor for thoracoabdominal aortic dilation after acute type A dissection repair [J/OL]. Interdiscip Cardiovasc Thorac Surg, 2024, 38(5): ivae063. doi: 10.1093/icvts/ivae063.
16.	Vo TX, Rahmouni K, Visintini S, et al. Computed tomography imaging measurements as a surrogate for clinical outcomes after surgical management of acute type A aortic dissection: a systematic review [J/OL]. J Am Heart Assoc, 2024, 13(18): e034496. doi: 10.1161/JAHA.124.034496.
17.	Ha NK, Jeong SS. Association between metabolic dysfunction-associated steatotic liver disease and risk of aortic aneurysm and dissection: a nationwide cohort study [J/OL]. J Clin Med, 2026, 15(14): 5453. doi: 10.3390/jcm15145453.
18.	Li Y, Fan N, He X, et al. Research progress in predicting hepatocellular carcinoma with portal vein tumour thrombus in the era of artificial intelligence [J]. J Hepatocell Carcinoma, 2024, 11: 1429-1438.
19.	D?rks M, Jobski K, Herget-Rosenthal S, et al. Tyrosine kinase inhibitors targeting vascular endothelial growth factor and the risk of aortic dissection-a pharmacovigilance analysis [J/OL]. Pharmacol Res Perspect, 2021, 9(1): e00707. doi: 10.1002/prp2.707.
20.	Okui J, Waki T, Kajiyama K, et al. Risk of artery dissection during systemic exposure to vascular endothelial growth factor pathway inhibitors [J/OL]. Clin Transl Sci, 2024, 17(12): e70096. doi: 10.1111/cts.70096.
21.	Xu J, Shen J, Gu S, et al. Camrelizumab in combination with apatinib in patients with advanced hepatocellular carcinoma (RESCUE): a nonrandomized, open-label, phase Ⅱ Trial [J]. Clin Cancer Res, 2021, 27(4): 1003-1011.

1. Hwang SY, Danpanichkul P, Agopian V, et al. Hepatocellular carcinoma: updates on epidemiology, surveillance, diagnosis and treatment [J/OL]. Clin Mol Hepatol, 2025, 31(Suppl): S228-S254. doi: 10.3350/cmh.2024.0824.
2. Chan YT, Zhang C, Wu J, et al. Biomarkers for diagnosis and therapeutic options in hepatocellular carcinoma [J/OL]. Mol Cancer, 2024, 23(1): 189. doi: 10.1186/s12943-024-02101-z.
3. Jiang M, Chen C, Hu Y, et al. Locoregional therapy combined with targeted therapy and immunotherapy for hepatocellular carcinoma with portal vein tumor thrombosis: a systematic review and meta-analysis [J/OL]. Sci Rep, 2025, 15(1): 39494. doi: 10.1038/s41598-025-23027-6.
4. 中華人民共和國國家衛生健康委員會醫政醫管局. 原發性肝癌診療指南(2022年版) [J]. 中華消化外科雜志, 2022, 21(2): 143-168.
5. Xu L, Wang B, Ding W. Abdominal aortic dissection during sorafenib therapy for hepatocellular carcinoma [J/OL]. Clin Res Hepatol Gastroenterol, 2017, 41(2): e24-e25. doi: 10.1016/j.clinre.2016.12.005.
6. Tsuchiya A, Ogawa M, Watanabe Y, et al. Successful treatment of aortic dissection during sorafenib therapy for hepatocellular carcinoma [J]. Clin Case Rep, 2018, 6(8): 1643-1644.
7. 李富波, 龔格格. 阿帕替尼治療晚期肝癌中出現主動脈夾層1例報道 [J]. 腫瘤防治研究, 2019, 46(7): 658-660.
8. Luo L, Liang H, Yuan L, et al. Potential synergistic effects of lenvatinib and aspirin in aortic dissection: a case report and literature review [J/OL]. Front Oncol, 2025, 15: 1520770. doi: 10.3389/fonc.2025.1520770.
9. Wu JJ, Hsu YC. Acute type A aortic dissection during vascular endothelial growth factor tyrosine kinase inhibitor lenvatinib therapy [J/OL]. Case Rep Crit Care, 2025, 2025: 3082479. doi: 10.1155/crcc/3082479.
10. 中華人民共和國國家衛生健康委員會醫政司. 原發性肝癌診療指南(2026年版) [J]. 中國普外基礎與臨床雜志, 2026, 33(4): 425-485.
11. 周旻, 符偉國. Stanford B型主動脈夾層診斷和治療中國專家共識(2022版) [J]. 中國血管外科雜志(電子版), 2022, 14(2): 119-130.
12. Carrel T, Sundt TM, von Kodolitsch Y, et al. Acute aortic dissection [J]. Lancet, 2023, 401(10378): 773-788.
13. Dai S, Zhong Y, Cui H, et al. Aortic dissection induced by vascular endothelial growth factor inhibitors [J/OL]. Front Pharmacol, 2023, 14: 1189910. doi: 10.3389/fphar.2023.1189910.
14. Cheng C, Nguyen MN, Nayernama A, et al. Arterial aneurysm and dissection with systemic vascular endothelial growth factor inhibitors: a review of cases reported to the FDA adverse event reporting system and published in the literature [J]. Vasc Med, 2021, 26(5): 526-534.
15. Kitada Y, Okamura H, Hasui H, et al. Morphologic prognostic factor for thoracoabdominal aortic dilation after acute type A dissection repair [J/OL]. Interdiscip Cardiovasc Thorac Surg, 2024, 38(5): ivae063. doi: 10.1093/icvts/ivae063.
16. Vo TX, Rahmouni K, Visintini S, et al. Computed tomography imaging measurements as a surrogate for clinical outcomes after surgical management of acute type A aortic dissection: a systematic review [J/OL]. J Am Heart Assoc, 2024, 13(18): e034496. doi: 10.1161/JAHA.124.034496.
17. Ha NK, Jeong SS. Association between metabolic dysfunction-associated steatotic liver disease and risk of aortic aneurysm and dissection: a nationwide cohort study [J/OL]. J Clin Med, 2026, 15(14): 5453. doi: 10.3390/jcm15145453.
18. Li Y, Fan N, He X, et al. Research progress in predicting hepatocellular carcinoma with portal vein tumour thrombus in the era of artificial intelligence [J]. J Hepatocell Carcinoma, 2024, 11: 1429-1438.
19. D?rks M, Jobski K, Herget-Rosenthal S, et al. Tyrosine kinase inhibitors targeting vascular endothelial growth factor and the risk of aortic dissection-a pharmacovigilance analysis [J/OL]. Pharmacol Res Perspect, 2021, 9(1): e00707. doi: 10.1002/prp2.707.
20. Okui J, Waki T, Kajiyama K, et al. Risk of artery dissection during systemic exposure to vascular endothelial growth factor pathway inhibitors [J/OL]. Clin Transl Sci, 2024, 17(12): e70096. doi: 10.1111/cts.70096.
21. Xu J, Shen J, Gu S, et al. Camrelizumab in combination with apatinib in patients with advanced hepatocellular carcinoma (RESCUE): a nonrandomized, open-label, phase Ⅱ Trial [J]. Clin Cancer Res, 2021, 27(4): 1003-1011.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Stanford A 型胸主動脈夾層術后殘留多發腹腔動脈慢性夾層合并肝癌 1 例報道及文獻復習

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