经皮热消融同步肝动脉化疗栓塞(TACE)治疗肝癌的临床价值

 目的  本研究旨在评估经皮热消融同步肝动脉化疗栓塞(transarterial chemoembolization,TACE)治疗肝癌的安全性、疗效及价值。方法  对单纯TACE疗效不佳的143位原发性肝癌患者的202个病灶(长径0.8~6.8 cm,中位直径3.3 cm)进行159次热消融同步TACE治疗。治疗程序为:先行肝动脉数字减影血管造影(digital subtraction angiography,DSA),接着超声导引下行热消融术(36次射频消融,123次微波固化治疗),最后行再次造影并超选择栓塞治疗(草酸铂+表阿霉素+碘油)。结果     同步治疗耐受性好,仅见轻微肝功能受损和血液毒性。严重并发症仅见2例肝脓肿、1例胸腔积液及1例胆道狭窄伴梗阻性黄疸。术中同步DSA可提高肿瘤影像显示率,精确确认肿瘤大小、数目及实际浸润范围包括卫星灶和微小转移灶;并可减少出血、局部残留、动静脉瘘及瘤道种植等并发症。本组同步治疗一次完全消融率达90.1%。中位治疗时间间隔8.3月(2~25月),1、2、3年生存率各为96.5%、87.4%、74.8%。结论  研究提示热消融同步TACE治疗肝癌安全有效,与单一治疗相比并未发现其他不良反应;该法扩大了肝癌热消融的适应证,提高一次完全消融率。

The clinical value of simultaneous percutaneous thermal ablation and transarterial chemoembolization (TACE) for liver cancer

Objective  The study aimed to evaluate the safety,efficacy and value of the simultaneous percutaneous thermal ablation and transarterial chemoembolization (TACE) for primary liver cancer (PLC).Methods  A total of 143 PLC patients with unsatisfactory results after previous TACE were enrolled treated with 159 percutaneous thermal ablations in 202 lesions (long diameter 0.8-6.8 cm,median 3.3 cm).The treatment schedule consisted of:initiative digital subtraction angiography (DSA),following percutaneous thermal ablations (36 procedures with radiofrequency ablation,123 procedures with microwave coagulation) under ultrasound and subsequential angiography plus TACE (with oxaliplatin,epirubicin and lipiodol).Results  The treatment was well tolerated,with transitory
 hepatic and hematological toxicity.Major complications included liver abscess in 2 cases,pleural effusion in 1 case,and biliary stenosis with obstructive jaundice in 1 case.The DSA during the operation could improve the discovery ratio of foci,confirm the size and real region of tumors including satellite nodule and micro metastasis,decrease the complications such as bleeding,residuals,artery portal vein fistula and neoplasm needle track implantation.The complete ablation rate was 90.1%.The median interval of local therapy was 8.3 months (2-25 months).The 1-,2- and 3-year cumulative survival rates among all 143 patients were 96.5%,87.4% and 74.8%,respectively.Conclusions  Simultaneous TACE plus percutaneous thermal ablation is safe and effective for treatment of liver cancer without other adverse reaction compared with single therapy.It enlarged the indications of percutaneous thermal ablation in liver cancer,and improved the complete ablation rate.