经动脉化疗栓塞术结合消融术治疗外生型肝癌

目的：探讨经动脉化疗栓塞术结合消融术治疗外生性肝癌疗效和安全性。方法：外生型患者37例，男35例，女2例；年龄19～72岁，平均47岁。肿瘤大小4．2cm×2．2cm～22．1cm×18cm。采用经动脉化疗栓塞术结合消融术治疗。结果：采用单纯TACE治疗4例，33例采用TACE结合消融术。共进行162次TACE术，平均4．38次。其中26例采用瘤内注药术，4例采用射频治疗，3例联合瘤内注药和射频。注药术采用碘油化疗乳剂17例，治疗53次，平均每例3．1次；8例采用无水乙醇，治疗17次；1例因乙醇弥散欠佳，改用冰醋酸瘤内注射，2次。射频治疗共15次。随访期间，未见严重并发症，1，2，3，4，5年生存率分别为82．6％，43．4％，21．7％，13％，8．1％。结论：经动脉化疗栓塞术结合消融术治疗外生性肝癌是有效和安全的。

Treatment of Exophytic Hepatocellular Carcinoma with Trans-arterial Chemo-embolism in Combination with Ablation

Objective：To study the efficacy and safety of trans-arterial chemo embolism （TACE） in combination with ablation in the treatment of exophytic hepatocellular carcinoma （HCC）. Method： 37 patients having exophytic HCC were treated by TACE in combination with ablation. The size of tumors ranged from 4. 2cm^3 × 2. 2cm^3 - 22. 1cm^3 × 18cm^3. Results：4 patients were treated by TACE only,33 patients were treated by TACE in combination with ablation. Altogether 162 times of TACE were performed （mean 4.38 times/patient）. Of these 33 patients,26 patients had intra-tumoral injection of chemo-therapeutic agents,4 patients had ablation, 3 patients had intratumoral injection of chemotherapeutc agents in combination with ablation. For the intra-tumoral agents injected, 17 patients had chemo therapeutic agents mixed with lipoidol emulsion,53 times of injection were performed （mean= 3.1 times/patient） ;8 patients （17 times） had pure ethanol injected;ethanol was shifted to glacial acetic acid due to the poor diffusion of ethanol within the tumor in 1 patient （2 times）. Radio-frequency ablation （RFA） were carried out in 4 patients （15 times）. No severe complication was found during follow-up. The 1-,2-,3-,4 ,5 year survival rates were 82. 6%,43. 4%,21.7%,13%,and 8. 1% respectively. Conclusion： TACE in combination with ablation is effective and safe in treating exophytic hepatocellular carcinoma.