肝动脉化疗栓塞治疗肝癌侵犯门静脉的疗效和安全性探讨

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 2 2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 2 7% ,平均成活时间为 2 3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 .0 0 1)。肝功能在 Child B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

Transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein invasion

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 for5 4 patients with hepatocellular carcinomas invading the major portal branches.TACE was per- formed with an emulsion of iodized oil and doxorubicin hydrochloride.All patients under- went multiple treatmentsessions. Results:Our initial findings showed that1 7patients had complete or partial remission,with an overall median survival time of 6 months.The cumu- lative survival rates were49% (6 months) ,2 9% (1 year) ,1 6 % (2 year) ,and8% (3year) . The parenchymal tumor extentwas the mostsignificantpredicting factor forthe complication and efficacy of the therapy.Of2 2 patients with a parenchymal tumor limited to one or two segments of a hepatic lobe,1 7had complete or partial remission,with a median survival time of2 0 months;this survival time was significantly longer than that(5 months) of the32 pa- tients with a more extensive tumor(P<0 .0 0 1 ) .Hepatic insufficiency developed in6 patients, and three of them died within 1 month after TACE.All 6 patients had an extensive parenchy- mal tumor involving more than two hepatic segments and four had impaired hepatic function- al reserve of Child class 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.