超声引导经皮穿刺荷瘤动脉栓塞化疗治疗进展期大肝癌临床应用

目的探讨超声引导经皮穿刺荷瘤动脉栓塞化疗(percutaneous tumor's artery chemoembolization, PACE)治疗进展期大肝癌的疗效和临床应用价值.方法经病理确诊43例进展期大肝癌,21例行PACE治疗,其中,9例为经股动脉插管肝动脉化疗栓塞(transcatheter arterial chemoembolization, TACE)疗效不满意者.对照组为同期行TACE治疗的22例,比较两种方法的治疗效果.两组病例平均年龄、病灶大小以及肝功能分级无显著性差异.结果 PACE组行肿瘤动脉穿刺治疗34次,穿刺成功率91.2 % (31/34),无一例发生严重并发症.治疗后PACE组5例缩小,占23.8 %(5/21),TACE组10例缩小,占45.5% (10/22),两组肿瘤缩小率比较无明显差异(P＞0.05).术后肝功能受损PACE组7 例,占33.3%(7/21);TACE组16例,占72.7% (16/22),二者有显著统计学差异(P＜0.05).PACE组平均生存期为11.2个月,最长1 例存活23个月;TACE组为14.6个月,最长1 例存活36个月.结论超声引导PACE术对肝功能损伤小可用于进展期大肝癌治疗,尤对TACE治疗无效者不失为一项补充治疗新技术,值得进一步深入研究.

Ultrasound guided percutaneous tumor's artery chemoembolization in treating advanced liver tumors

Objective To investigate clinical efficacy of percutaneous tumor's artery chemoembolization (PACE) in treating advanced liver tumors. Methods Forty-three advanced liver tumors confirmed by pathology were divided into two groups. Twenty-one patients were in PACE group, 9 of which had failed to transcatheter arterial chemoembolization (TACE). Twenty-two patients were in TACE group. There was no significant difference between the two groups in age of the patients, size of tumors and function of the liver. Results Thirty-four times of puncture were performed in PACE group with the puncture success rate of 91.2% (31/34). No major complication occurred. Tumor shrinkage was found in 5 cases in PACE group with the rate of 23.8% (5/21), while in TACE group, it was found in 10 cases with the rate of 45.5% (10/22). But no significant difference (P>0.05) was found between the two groups. Liver function damage was found in 7 cases in PACE group (33.3%,7/21) and 16 cases in TACE group (72.7%,16/22) with significant difference (P<0.05). The average survival was 11.2 months in PACE group and 14.6 months in TACE group with the longest survival of 23 and 36 months, respectively. Conclusion With minimal injury to the liver, ultrasound-guided PACE could be safely applied in patients with advanced liver tumor, which would be considered as a new adjuvant method for patients failed to TACE. Further study on this intervention is needed.