经皮穿刺瘤内注入碘油化疗药乳剂治疗原发性肝癌

目的 探讨经皮穿刺瘤内注入碘油化疗药乳剂(CALE)治疗原发性肝癌的疗效和安全性.方法 本组57例患者中肝细胞癌49例,胆管细胞癌8例.共进行了90例次的治疗,即分90个靶区.术前均已行经动脉化疗栓塞术(55例)或化疗灌注术(2例).所有患者动脉造影均表现为少血供或不能插管人供血动脉者.在透视或者CT引导下,经皮穿刺注入CALE.术后1周内行X线平片或CT和实验室检查.术后1个月、3个月、6个月、1年随访,以后每6个月随访一次.残留灶复发者,行再次治疗.结果 57例原发性肝癌患者,行90例次治疗.均穿刺和注药成功,技术成功率为100%.靶区大小及CALE的用量为:肿瘤直径<3 cm者40例次,乳剂剂量3.0～7.0 ml;3～5 cm者43例次,乳剂剂量12.0～20 ml;>5 cm者7例次,乳剂剂量为24～40 ml.AFP阳性患者43例,治疗后14例降到正常范围.术后1个月CT显示CALE在靶区沉积良好者54例次(60.0%),欠佳者34例次(37.7%).缺失者2例次.随访2个月～6年,中位随访时间16个月.患者中位生存时间400 d.术后的主要副作用有:发热22例次(24.4%),恶心、呕吐等胃肠反应11例次(12.2%),穿刺部位疼痛17例次(18.9%),均自行缓解.结论 采用经皮穿刺瘤内注射CALE治疗原发性肝癌是有效和安全的.

Percutaneous intratumoral injection of lipiodol and chemotherapeutic agents emulsion for primary liver cancer

Objective To evaluate percutaneous intratumoral injection of chemotherapeutic agents lipiodol emulsion (CALE) for the treatment of primary liver cancer. Methods This study included 57 patients of hepatocellular carcinoma (n=49) and intrahepatic cholangiocarcinoma (n=8).53 were male and 4 were female,with a mean age of 48.02 years(range,19～70 years).In all,ninety CALE injections were assigned to 90 target areas within the lesions.Before the procedures,transcathetcr arterial chemoembolization (n=55) or infusion (n=2) was carried out in these patients.By arteriography,low blood supply of target areas was showed or it was concluded that superselective catheterization of supply arteries of lesions could not accomplished.Percutaneous intratumoral CALE injection was carried out under fluoroscopy or CT guidance.Therapeutic effect,side effect and complications were assessed based on clinical manifestation,laboratory examination and fluoroscopy or CT one week after procedure.Follow-up was carried out after 1,3,6 months and 1 year,and once every six months thereafter.Local recurrences were treated according to patients'will.Results 90 sessions of percutaneous injection were successfully performed on 57 patients,with 100% technique success rate.The volume of CALE iniected per session ranged 3.0-7.0 ml(mean,6.0 ml) in target size less than 3 cm,12.0-20 ml(mean,15 ml)in target size of 3-5 cm and 24-40 ml in target larger than 5 cm.Serum AFP was positive in 43 patients and decreased to normal in 14 patients(28%).54 lesions(60%)were with well distribution of the lipiodol-chemotherapy mixture on CT 1 month after procedure.Follow-up ranged from 2 months to six years(mean,16 months).The median survival time was 400 d.The cumulative survival rates at 200 d,600d was 85%and 30%,respectively.Complications included fever (n=22,24.4%),nausea and vomit(n=11,12.2%),and pain at the puncture site (n=17,18.9%).Conclusions Percutaneous intratumor CALE injection is safe and effective for the treatment of primary liver cancer.