贲门癌肝转移的血供特点及其与经动脉化疗栓塞疗效的相关性

目的探讨贲门癌肝转移的血供特点及其与经动脉化疗栓塞治疗效果的关系。方法对42例经临床和病理组织学证实的贲门癌肝转移患者同时行贲门及肝脏肿瘤靶动脉栓塞化疗术。随后,在所有患者中观察了病灶血供特点,并评价了经动脉化疗栓塞治疗的效果及生存率。结果贲门癌病灶主要由胃左动脉供血,左膈下动脉、胃右动脉及肝左动脉可能参与供血。肝转移瘤由肝动脉供血,其中富血供、染色征明显者6例(14.3%),治疗有效率为83.3%;血供中等、染色较淡28例(66.7%),治疗有效率为53.5%;血供稀少、染色呈淡絮状或无明显染色8例(19.0%),治疗有效率为37.5%。经动脉化疗栓塞术后,0.5、1、2、3、5a生存率分别为90.4%,76.1%,33.3%,7.1%和2.4%。本组患者于诊断后中位生存期为19.6个月。结论经动脉化疗栓塞治疗是贲门癌肝转移的有效治疗方法,富血供肿瘤疗效优于乏血供肿瘤。

Blood-supply features of hepatic metastases from cardial cancer and their relation to therapeutic efficacy of TACE

Objective To investigate the blood-supply features of hepatic metastases from cardial cancer and their relation to therapeutic efficacy of transarterial chemoembolization（TACE）.Methods Forty-two patients with clinically and histopathologically proved hepatic metastases from cardial cancer underwent TACE via cardial and hepatic tumor target arteries.Subsequently,observing the blood-supply features of metastatic lesions and evaluating the therapeutic efficacy of TACE and the survival rate were carried out in all the patients.Results Digital subtraction angiography（DSA） demonstrated that the blood-supply of cardial cancers was predominanted by left gastric artery but left subphrenic artery,right gastric artery and left hepatic artery could participate in their blood-supply.The blood-supply of hepatic metastases was predominanted by hepatic arteries,of them,the metastases with rich blood-supply and obvious staining were found in 6 （14.3%） cases in whom the effective rate of TACE was 83.3%（5/6）;middling blood-supply and light staining in 28（66.7%） cases in whom the effective rate of TACE was 53.5%（15/28）;poor blood-supply and pale flocculent staining or even stainless in 8（19.0%） cases in whom the effective rate of TACE was 37.5%（3/8）.The 0.5-,1-,2-,3-,and 5- year survival rates after TACE were 90.4%,76.1%,33.3%,7.1%, and 2.4%.Median survival time from the start of TACE was 19.6 months.Conclusion TACE is an optimal therapy in treating hepatic metastases from cardial cancer,while the efficacy of TACE in rich blood-supply tumors is significantly superior to that in poor blood-supply tumors.