肝癌不同方式介入治疗后手术切除标本的病理研究

目的：探讨3种不同方式介入治疗后肝癌切除标本的病理改变及其意义。方法：肝细胞肝癌30例，其中10例行常规经导管肝动脉栓塞化疗（C－THAE），10例行节段性肝动脉栓塞化疗（S－THAE），10例行肝动脉栓塞化疗联合经皮无水乙醇注射（PEI）治疗。3组病例临床资料具有可比性。所有病例最后1次介入治疗后4－8周行手术切除，标本送病理检查。结果：在癌灶坏死，包膜浸润坏死和门脉癌栓坏死方面，节段组与联合组明显高于常规组，统计学处理差异有显著性意义；节段组和联合组比较则差异无显著性意义，但联合组将癌灶，包膜浸润及门脉癌栓3项指标的完全坏死率分别由节段组的80％，71％和75％提高到100％，83％和86％。在常规组（8例）与节段组（2例），包膜内尚可见连接非癌肝组织内门静脉的侧支循环。此外，行常规栓塞的病例对癌周非癌肝组织取材的各个层面均可见散在分布的假小叶坏死及肝细胞变性与坏死，而行节段性栓塞的病例仅于癌周1cm以内可见类似改变。结论：病理结果提示S－THAE对肿瘤组织的杀伤能力明显强于C－THAE，对非癌肝组织的损害明显轻于C－THAE；PEI可以起到杀死残余癌灶，提高包膜浸润坏死率和门脉癌栓坏死率的作用。病理结果还显示门脉系统与残余癌灶的供血。

Pathological study of resected specimens of hepatocellular carcinoma after different ways of interventional treatment

Objective To investigate the pathological changes and its significance in resected specimens after three kinds of interventional therapeutic ways for hepatocellular carcinomas (HCCs). Methods Ten cases of HCCs were treated by conventional transcatheter hepatic arterial embolization (C-THAE) in group A, 10 cases were treated by segmental transcatheter hepatic arterial embolization (S-THAE) in group B, and 10 cases were treated by a combination therapy of C-THAE or S-THAE and percutaneous ethanol injection (PEI) in group C. There were constant clinical materials among three groups. All patients underwent resection in 4-8 weeks after the final interventional treatment. The resected specimens were studied by pathologists. Results Group B and group C were superior to group A with extraordinary remarkable difference on the tumor necrosis, the necrosis of invaded capsule, and the necrosis of tumor thrombus in portal vein. There was no significant difference between group B and group C. But the complete necrosis rates of the above-mentioned three indexes were improved from 80%, 71%, and 75% in group B to 100%, 83%, and 86% in group C,respectively. Collateral circulations inside capsule connecting portal vein in noncancerous hepatic tissues were found in group A (8 cases) and group B (2 cases). In addition, necrosis of pseudolobuli and degeneration or necrosis of hepatic cells were found on all sections of noncancerous hepatic tissues around tumor in patients treated by C-THAE, but the similar changes could be seen only on the sections within 1 cm near tumor. Conclusion S-THAE has much stronger ability to kill the tumors and much less damage on noncancerous hepatic tissues compared with C-THAE. PEI plays an important role in killing the residual tumors and improving the necrosis rates of invaded tumors in capsule and tumor thrombus in portal vein. It has also been proved that portal vein takes part in the blood supply of residual tumors.