经皮微波固化联合肝动脉化疗栓塞治疗碘油存留较少原发性肝癌.docVIP

经皮微波固化联合肝动脉化疗栓塞治疗碘油存留较少原发性肝癌 　【摘要】 　　目的 观察经皮微波固化治疗联合肝动脉化疗栓塞治疗碘油存留较少的原发性肝癌的疗效。方法 60例曾经进行肝动脉化疗栓塞且碘油存留较少肝癌的患者随机分为两组。联合治疗组30例患者在进行肝动脉化疗栓塞后给予经皮穿刺微波固化治疗，对照组30例患者仅行肝动脉化疗栓塞治疗。结果 联合治疗组和对照组的近期有效率分别为70% 和53.3%，联合治疗组没有增加严重并发症。结论 经皮微波固化联合肝动脉化疗栓塞治疗可提高碘油存留较少的原发性肝癌的近期疗效。 【关键词】 肝肿瘤/治疗　微波固化　肝动脉；化疗栓塞 　　Percutaneous Microwave Coagulation Combined with Transcather Hepatic Arterial Chemoembolization in the Treatment of Primary Liver Cancer with Poor Lipiodol Distribution Shandong Tumor Hospital,Jinan 250117,ChinaAbstract：Objective To investigate the therapeutic effect of percutaneous microwave coagulation combined with transcather hepatic arterial chemoembolization(TACE) in the treatment of primary liver cancer with poor lipiodol distribution.Methods Sixty cases having been treated by TACE were randomly divided into two groups.30 patients (combination group) were treated by percutaneous microwave coagulation therapy after TACE.The other 30 patients (control group) were treated by TACE alone.Results The response rates（CR+PR）in the combination group and control group were 70% and 53.3% respectively.There were no additional severe complications in combination group.Conclusion The treatment of percutaneous microwave coagulation combined with TACE is safe and helpful to increase response rate for primary liver cancer patients with poor lipiodol distribution. Key words：Liver neoplasms/Therapy; Microwave coagulation; Hepatic artery; Chemoembolization 　2004年7月～2005年6月，我科对30例不能手术且经肝动脉化疗栓塞后碘油存留较少的肝癌患者采用TACE联合超声引导下经皮穿刺微波固化治疗，并与单纯TACE患者的近期疗效进行比较，结果总结报道如下： 1资料与方法 1.1病例选择 60例患者根据中国常见恶性肿瘤诊治规范临床诊断为原发性肝癌[1]，至少已进行过1次TACE治疗，复查CT见碘油沉积不理想，肝功能ChildPugh分级A级或B级，预计生存期＞3个月。随机分为联合治疗组和TACE组。联合治疗组30例患者进行TACE治疗1周后行微波固化治疗，TACE组30例患者仅行TACE治疗。两组患者的临床资料具有可比性，见表1。表1两组患者临床资料 1.2治疗方法 所有患者进行TACE治疗，治疗方案为5Fu 750～1000mg、DDP40～80mg、MMC 10～20mg或EADM40～60mg加38%超液化碘油5～20ｍl。综合治疗组在TACE治疗1周后进行微波治疗，微波仪选用南京起亚MTC3型，输出功率0～100W，连续可调，微波频率2450MHz。治疗前应用彩色多普勒超声观察肿瘤及周边栓塞后血流情况，寻找周边血管，确定穿刺部位（左叶选剑突下，右叶选择第7、8、9肋间）。常规消毒铺手术巾后行局部麻醉（对肝包膜多点麻醉），