小肠平滑肌类肉瘤肝转移的影像学评价和介入治疗

目的 评价小肠平滑肌类肉瘤肝脏转移的影像学表现和介入治疗的短期疗效。方法 回顾性分析7例小肠平滑肌类肉瘤肝脏转移病例，共计46个病灶。病灶直径2-18cm不等。所有患者均行肝脏CT三期扫描和肝动脉造影。介入治疗7例均采用肝动脉化疗栓塞术（TACE），1例行左锁骨下动脉植入化疗药盒导系统术（肝动脉PCS术）。3例肿瘤中心液化坏死明显的患者还行经皮坏死物引流和肿瘤内无水酒精注射。结果 46个肝脏转移病灶均表现为实质性或囊实性占位，肿瘤较大时囊变成份增加。CT动脉期增强扫描肿瘤明显强化，肝动脉造影肿瘤血管、染色丰富。随访3-10月（平均6.7月），4例经肝TACE术后肿瘤缩小，1例进行肝动脉PCS要患者肿瘤大小无变化，2例肿瘤增大。3例经皮肿瘤坏互物引流者肿瘤缩小明显。结论 小肠平滑肌类肉瘤肝脏转移以肝动脉供血为主，为富血供肿瘤。肝TACE术、肝动脉PCS术和经皮坏死物引流术是其治疗的有效方法。

Imaging evaluation and interventional therapy of hepatic metastases from small intestinal leiomyosarcoma

OBJECTIVE: To evaluate the imaging appearances and the short-term curative effect of hepatic metastases from small intestine leiomyosarcoma treated by interventional methods. METHODS: Seven cases with 46 lesions of hepatic metastases from small intestinal leiomyosarcoma were analyzed retrospectively. The diameters of the metastases were from 2 cm to 18 cm. CT triphasic scan and hepatoarterial angiography were performed in all cases. The interventional therapy methods included transcatheter arterial chemoembolization (TACE) (all 7 cases), percutaneous left subclavian artery port-catheter system implantation (PCS) (1 case). Three cases were also treated with percutaneous tumor necrosis drainage (PTND) because of obvious liquefaction necrosis within the tumor. RESULTS: The lesions were substantial occupation and some were mixed density with cystic component. The cystic component increased in the larger tumor. The hepatic metastases were enhanced remarkably during the hepatic arterial-dominant phase scan and had abundant tumor vascular and tumor stain on hepatoarterial angiography. The size of tumor in 4 cases was reduced after TACE. The tumor in the patient who was treated with PCS had no changed. The size of the tumor in 3 cases was slightly enlarged. The tumors in the 3 patients treated with PTND were reduced remarkably. CONCLUSIONS: The predominant blood-supply of the hepatic metastases from small intestinal leiomyosarcoma is the hepatic artery abundant in blood vessels. TACE, PCS and PTND are effective methods to treat hepatic metastases from small intestinal leiomyosarcoma.