原发性肝癌介入治疗中小颗粒性栓塞剂合理使用.docVIP

原发性肝癌介入治疗中小颗粒性栓塞剂合理使用 　　【摘要】 目的观察、分析肝动脉化疗栓塞后“血管门残留现象”成因,寻求对策。方法 60例块状型原发性肝癌患者,分别采用常规方法栓塞(A组,n=30),小颗粒栓塞(B组,n=30)。观察两组残留现象的发生率及中期疗效。结果 治疗后即时,A组“残留现象”占86.7%,B组占43.3%有明显差异(P0.01),A组一年生存率为60%,B组为83.3%。结论 肿瘤动脉插入式供血血管门区域血管管径粗血流速度快、相对容易形成侧支血供和常规栓塞治疗中常出现的假性完全性栓塞为“残留现象”的主要形成原因。 　　【关键词】 肝细胞癌;栓塞;血管门;残留现象 　　 　　Reasonable use of shortgrained embolization in interventional therapy of primary carcinoma liver 　　MA Xiao-ou. 　　Department of Radiology at the Second Affiliated Hospital of Qiqihaer Medical College in the Heilongjiang,Qiqihaer 161006,China 　　【Abstract】 Objective To observe the tumor hilar remnant phenomenon(THRP) after transcatheter arterial chemoembolization,and to analyze the fators of its formation,in order to find a countermeasure of reatment.Methods There were 60 patients with primary hepatocellular carcinoma of massive type.The cases in early stage were treated by conventional TACE (Group A,n=30),shortgrained embolization (Group B,n=30).The incident rate of (THRP)and the effects of therapy were compared between the two groups.Results The incident rate of THRP was 86.7% in Group A and 43.3% in Group B(P0.01) just agter the first time.The one-year survival rate was 60% in Group A and 83.3% in Group B.Conclusion The main factors of THRP formation include the inserted feeding tumor arteries,the bigger vessel diameter and the faster blood flow in the hilar of tumor,the easier collateral bllod supply,and the false complete TACEwhich is usually to be found in conventional TACE. 　　【Key words】 Hepatocellular carcinoma;Embolization;Tumor hilar;Remnant phenomenon 　　 　　原发性肝癌治疗手段主要包括外科切除、介入治疗、基因治疗、中药治疗。其发病率、死亡率高,手术切除率很低且术后复发率较高,外科治疗对早期病变效果好。但是肝癌发现后多属中晚期,能够进行手术切除的并不多,大部分还需要其他治疗。因此大多数原发性肝细胞癌需要疗效肯定的非手术方法,目前,肝动脉化疗栓塞(TACE),是中晚期肝癌的最有效且发展比较成熟的一种方法。但在经TACE治疗块状型原发性肝癌的过程中,经常可以观察到碘油化疗乳剂不易在肿瘤近供血动脉进入区域完全沉积,并且术后肿瘤常在该区域复发,称之为“血管门残留现象”,(以下简称残留现象),“残留现象”是动脉栓塞术的不完全清除特性在肿瘤化疗栓塞治疗中的表现。而“残留现象”是块状型肝癌复发的主要原因,对“残留现象”的处理仍然是肝癌介入治疗的一大难题。笔者通过合理使用小颗粒性栓塞剂应对“残留现象”,研究的主要目的是观察分析肝动脉化疗栓塞的“残留现象”成因,寻求应对方法,以降低残留现象的