影响原发性肝癌LP—TAE疗效的因素分析

1988年4月至1990年12月,以碘油—抗癌剂混悬液及明胶海绵碎粒栓塞肝癌的供血动脉(Lp—TAE)治疗原发性肝癌178例,累积生存率(Cumulative Survival Rate)分别是一年67.97％和二年43.51％。认为LP—TAE是肝癌的最好姑息手段。如何进一步提高疗效使姑息变成治愈?作者对178例患者的肝动脉造影,CT扫描片,手术病理标本等资料进行了对比分析,认为碘油抗癌药物混悬液沉积不充分是病灶未能完全被消灭的关键。影响药物充分沉积的主要因素是:①肝癌乏病理血管;②药量不足;③癌灶内严重的动静脉分流;④没有用明胶海绵栓塞或栓塞不充分;⑤肝动脉外供血;⑥混悬液制作不良等。强调了首次LP—TAE的重要性。

FACTORS INFLUENCING THE THERAPEUTIC EFFECT OF LIPIODOL-ANTICARCINOGEN TRANSCATHETER ARTERIAL EMBOLIZATION (LP-TAE) FOR PRIMARY HEPATIC CARCINOMA (PHC)

It is believed that LP-TAE is the best palliative treatment but not the curative measurement in many cases. For clarifying the cause, the analysis of the therapeutic results of 178 cases of PHC was carried out. According to the monitoring CT scan, angiography and pathology of the 16 resected specimens which revealed that incomple filling with the emulsion of lipiodol and anticarcinogens in tumor was the source of recurrence. The factors for incomplete filling include: 1, hypovascular shucture in tumor, 2, inadequate quantity of the emulsion; 3, A-V shunt and coarse tumor vessels; 4, no or ineffective embolization; 5, blood supply from vessels other than hepatic artery; 6, gravitational gradients; 7, improper preparation of the emulsion and 8, zbliteration or high grade stenosis of the feeding artery after the first LP-TAE jeopardizing the further filling.