微导管亚肝段栓塞技术在小肝癌中的应用评价

[目的]探讨微导管亚肝段栓塞治疗小肝癌的价值。[方法]16例小于3cm的小肝癌,用微导管行亚肝段动脉栓塞,4例联合无水酒精消融,4例手术切除。治疗后定期复查CT和AFP,4例手术切除后病理分析。[结果]摇栓塞后1个月CT复查病灶直径缩小1/2以上6例,缩小1/3以上8例,其中14例AFP定量升高的病例治疗后降至正常6例,明显下降4例,4例下降不明显。2个月复查病灶缩小1/2以上增至9例。对4例AFP降低不明显者,施加经皮无水酒精注射(PEI)治疗,术后1个月复查病灶和AFP均有明显缩小和降低。另有4例栓塞1个月后手术切除,病理检查显示病灶内癌细胞完全坏死3例,1例病灶边缘有少许存活癌细胞。[结论]微导管亚肝段栓塞技术能有效阻断肿瘤血供,使病灶缩小和AFP降低,并能绝大部分杀灭癌细胞。对肿瘤缩小、AFP下降不明显的患者,PEI是一个有效的补充治疗。

Applying Subsegmental Transcatheter Arterial Chemoembolization for Small Hepatocellular Carcinoma

To evaluate the clinical value of subsegmental transcatheter arterial chemoembolization(S-TACE)in the treatment of small hepatocellular carcinoma(SHCC).Sixteen cases of SHCC(<3cm)were treated by S-TACE,4cases combined with percutaneous ethanol injection(PEI)and4cases underwent operation.After treatment of S-TACE,CT and AFP were examined.The resected specimens were pathologically analyzed.CT showed that the size of tumor reduced more than1/2in6cases,more than1/3in8cases after one month,AFP recovered to normal range in6cases,obviously reduced in4cases,no obviously reduced in4cases.In the4cases without obvious AFP reduction,both tumor size and AFP remarkably reduced after combining PEI treatment.Of4cases underwent operation following S-TACE1month,pathology revealed tumor complete necrosis in3cases,and1case with a few residual cancer cells at margin.[Conclusion]S-TACE can effectively block blood supply of tumor,reduce the size and AFP level of tumor.PEI is an effective supplementary therapy to the patients who are not effective to S-TACE.