胆囊动脉供血肝癌TACE治疗45例

目的:评估经导管动脉内化疗栓塞术(transcatheter arterial chemoembolization,TACE)治疗不能切除的、由胆囊动脉供血肝细胞癌(hepatocellular carcinoma,HCC)的安全性、插管成功率及其疗效.方法:收集我院45例经TACE治疗的由胆囊动脉供血的肝癌患者.36例患者以前曾行2-8次TACE术(平均4次),自初次治疗后的存活期为4-69 mo(平均24 mo).9例患者在首次血管造影时即发现胆囊动脉寄生.TACE技术只有在微导管能插入肿瘤供血动脉分支,并且造影不出现胆囊壁染色时才能进行.我们对其治疗效果及并发症作了回顾性分析.结果:28个肿瘤完全由胆囊动脉供血,17个由肝动脉及胆囊动脉共同供血.60%(n=27)的患者可以观察到肝动脉的变细或闭塞.32例患者(71%)成功地进行了栓塞治疗而无严重并发症出现.28例患者(62%)有足够的碘油聚集.这28例患者在平均随访18mo后仅有6例(21%)肿瘤局部进展.对于栓塞不成功的13例(29%)患者,分别给予经皮注射无水乙醇治疗(n=6),放疗(n=4)以及胆囊切除术后的TACE(n=3).结论:71%的患者经胆囊动脉行TACE治疗是安全可行的.如果肿瘤能获得足够的碘油聚集,理想的治疗效果还是值得期待的,本组有62%(n=28)的患者获取良好的碘油聚集.

Transcatheter arterial chemoembolization for hepatocellular carcinoma fed by the cystic artery:A report of 45 cases

AIM:To evaluate the safety,technical success rate,and effectiveness of transcatheter arterial chemoembolization(TACE) for unresectable hepatocellular carcinoma(HCC) fed by the cystic artery.METHODS:Treatment of 45 tumors in 45 patients fed by the cystic artery was attempted with TACE.Thirty-six patients had previously undergone one to eight TACE sessions(mean,four sessions),and the duration after initiation of treatment of HCC was 4 to 69 mo(mean,24).In 9 patients,parasitization of the cystic artery was revealed at initial angiography.TACE was performed only when the microcatheter could be inserted into the tumor feeding branch and the stain of the gallbladder wall disappeared.The therapeutic effects and complications were retrospectively analyzed.RESULTS:Twenty-eight tumors were completely fed by the cystic artery and 17 were fed by both the hepatic artery and cystic artery.Attenuation or occlusion of the hepatic artery was observed in 60%(n=27) of tumors.The tumor feeding branch arising from the cystic artery could be successfully embolized in 32 tumors(71%) of 32 patients without severe complications.Adequate iodized oil accumulation was achieved in 28 tumors(62%) of 28 patients.Local progression was observed in 6(21%) of these 28 tumors treated by TACE alone during a mean follow-up period of 18 mo.Percutaneous therapy(n=6),radiation(n = 4),and TACE after cholecystectomy(n=3) were added for tumors with incomplete or unsuccessful TACE.CONCLUSION:TACE via the cystic artery was safe and technically possible in 71% of patients.If adequate iodized oil accumulation is obtained,which was achieved in 62% of our patients,suff icient therapeutic effect may be expected.