摘要
目的：评价肝动脉化疗栓塞（ＴＡＣＥ）治疗肝癌侵犯门静脉的疗效和安全性。方法：采用选择性肝动脉插管，造影证实靶血管存在后，先注入适量碘化油－抗癌药乳化剂栓塞肿瘤血管，再注入适量三联抗癌药。根据肝癌侵犯门静脉的大小，将其分为局限型和弥漫型两类，并对这两类肝癌经ＴＡＣＥ治疗后的初期（＜６个月）和长期疗效及安全性进行随访。结果：发现２２例局限性肝癌的初期缓解率为７７％，长期疗效随访６个月的累计成活率为８２％，１年成活率为６２％，３年成活率为２７％，平均成活时间为２３个月。３２例弥漫性肝癌的初期缓解率为１８％，长期随访６个月的累计成活率为３３％，１年成活率为１４％，２年成活率为８％，３年成活率为２％，平均成活时间为５个月，两组差异非常显著（Ｐ＜０．００１）。肝功能在ＣｈｉｌｄＢ级以下，行ＴＡＣＥ治疗并发症多，被视为相对禁忌证。结论：肝动脉化疗栓塞治疗肝癌侵犯门静脉的疗效和安全性与原发癌的大小、侵犯门静脉的程度密切相关，癌肿较局限伴门静脉侵犯者，ＴＡＣＥ治疗疗效较好而且较为安全。
Objectives:To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE) therapy in a series of patients with hepatocellular carcinomas with portal vein invasion. Methods:We retrospectively analyzed the results of TACE for 54 patients with hepatocellular carcinomas invading the major portal branches. TACE was performed with an emulsion of iodized oil and doxorubicin hydrochloride. All patients underwent multiple treatment sessions. Results: Our initial findings showed that 17 patients had complete or partial remission, with an overall median survival time of 6 months. The cumulative survival rates were 49%(6 months), 29%(1 year),16%(2 year),and 8 %(3 year). The parenchymal tumor extent was the most significant predicting factor for the complication and efficacy of the therapy. Of 22 patients with a parenchymal tumor limited to one or two segments of a hepatic lobe,17 had complete or partial remission, with a median survival time of 20 months; this survival time was significantly longer than that(5 months) of 32 patients with a more extensive tumor(P<0.001).Hepatic insufficiency developed in 6 patients, and three of them died within 1 month after TACE.All 6 patients had an extensive parenchymal tumor involving more than two hepatic segments and four had impaired hepatic functional reserve of Child B. Conclusions: When a tumor is limited in extent and hepatic functions preserved, TACE is effective and safe for the palliation of hepatocellular carcinoma with major portal vein invasion. However,when a parechymal tumor is extensive, TACE is associated with a poor response and a risk of hepatic failure.
出处
《南京大学学报（自然科学版）》
CAS
CSCD
1998年第2期183-186,共4页
Journal of Nanjing University（Natural Science）
关键词
肝动脉栓塞化疗
肝癌
门静脉
治疗
安全性
Liver neoplasms
Interventional radiology
Hepatic artery
Transcatheter chemoembolization
