胃肠道癌肝转移DSA表现与肝动脉化疗栓塞近期疗效的关系

目的 探讨胃肠道癌肝转移数字减影血管造影（DSA）表现与肝动脉化疗栓塞（TACE）近期疗效的关系。方法 胃肠道癌肝转移患者255例，经病理组织学检查确诊为腺癌，原发灶均被切除，所有患者在TACE中均先进行肝动脉DSA，根据肝内转移瘤的动脉供血情况、瘤体的染色程度，将转移瘤的血供类型分为3种：富血供、中等血供和乏血供，并判定肝转移瘤的DSA表现及其与TACE近期疗效的关系。结果 255例患者中富血供者34例、中等血供者69例、乏血供者152例；富血供者中有效者（CR+PR）25例，中等血供中有效者（CR+PR）17例，乏血供者中有效者（CR+PR）31例；富血供型与中等血供型、乏血供型组间近期疗效的差异均有统计学意义（P＜0.01），而中等血供型与乏血供型近期疗效的差异无统计学意义（P＞0.05）。所有患者行TACE后均出现不同程度的恶心、呕吐、肝区不适或疼痛，未出现肝功能衰竭，未见相关的严重并发症发生。结论 胃肠道癌肝转移瘤的血供类型以乏血供型为主；TACE对胃肠道癌肝转移瘤富血供者的疗效明显优于中等血供和乏血供者，对于中等血供型和乏血供型肿瘤应结合非血管性介入治疗的方法，以提高疗效。

DSA manifestation in hepatic metastases from gastrointestinal cancer and its relation with short-term therapeutic efficacy of transcatheter arterial chemoembolization

bjective To investigate the manifestation of digital subtract angiography（DSA） in hepatic metastases from astrointestinal cancer and its relationship with the short term efficacy of transcatheter arterial chemoembolization（TACE）. Methods 255 patients，who were in hospital with hepatic metastases from gastrointestinal cancer， were involved in the study. Primary tumors of these patients had been resected. Their pathology types were adenocarcinoma. All patients were given the hepatic trterial digital subtract angiography（DSA） before TACE. Based on the observation of the arterial blood supply in intrahepatic metastatic tumor，these blood supply were divided into the hypervascular pattern（n=34），the isovascular pattern（n=69） and the hypovascular pattern group（n=152） in order to investigate the relationship between the manifestation of hepatic metastases from gastrointestinal cancer and their short term therapeutic efficacy of TACE. Results After TACE, the clinical effective rate（CR+PR） of hypervascular， isovascular and hypovascular pattern group was 73.5％（25／34），24.6％（17／69） and 20.4％（31／152）, respectively. A significant difference in short term therapeutic efficacy existed between hypervascular and isovascular group as well as between hypervascular and hypovascular group（P＜0.01），while no significant difference existed between isovascular and hypovascular group（P＞0.05）. All patients appeared different degree of nausea， vomiting， liver area unwell or pain after TACE， there was no significant difference in 3 groups. No liver failure， serious complications associated with interventional therapy were occured in all patients. ConclusionThe main blood supply of hepatic metastases from gastrointestinal cancer is hypovascular pattern. Compared with isovascular and hypovascular tumor， TACE is much more effective in treating hypervascular patients suffering from hepatic metastases by gastrointestinal cancer. Non-vascular interventional therapy should be invited to treat isovascular and hypovascular tumors.