块状型肝癌化疗栓塞后血液动力学改变的临床意义

目的：探讨块状型肝癌化疗栓塞（TACE）后肝内血管血流动力学改变的临床意义。方法：对51例肝右叶块状型肝癌患者行TACE治疗，采用Seldinger技术将微导管超选择至肿瘤的供血动脉，经栓塞-化疗-再栓塞后再次行DSA造影检查。TACE术前、术后两次造影条件相同，观察肿瘤区和非肿瘤区血流动力学变化。结果：51例中，肿瘤组织内动脉有增生或显著增生的血管网43例（84．3％），主瘤栓塞后DSA检出1～3个大小不等的次瘤34例（66．7％）。TACE后，肿瘤区血管密度减小、非肿瘤区血管密度增大，肝固有动脉、肝右动脉和胃十二指肠动脉管径增粗、血流量增多。结论：TACE后肝肿瘤区血流速度减慢，有利于化疗药物和栓塞剂的存留。主瘤栓塞后次瘤的发现，对于手术治疗的取舍有重要的参考价值。观察TACE前后血流动力学的变化为肿瘤综合治疗方案的拟定提供了有价值的临床信息。

Clinical Significance of Haemodynamic Changes after Transcatheter Arterial Chemoembolization in Massive Hepatocellular Carcinoma

Objective ：To investigate the clinical significance of intrahepatic haemodynamic changes detected by digital subtraction angiography （DSA） after transcatheter arterial chemoembolization （TACE） in massive primary hepatocellular carcinoma （ PHC ）, Methods ： Fifty cases with massive PHC accepted TACE, in which microtubules were introduced into feeding arteries of tumors by Seldinger technique. The DSA was performed on these patients before and after TACE in the same condition, in order to observe the haemodynamic changes in the areas of tumors and non-tumors. Results：The DSA revealed that arterial hyperplasia or hyperplastic vascular net in 43 cases （84.3%） and 1-3 of secondary tumors in 34 （66.7%） after main tumors had been embolized. Following TACE, the vascular density was decreased in the neoplastic regions and increased in the normal areas. The inner diameters of proper hepatic artery, right and left hepatic arteries, and gastroduodehal artery were thickened and the blood flow in these arteries was increased. Conclusions：The decreased blood flow of tumors following TACE contributes to the retention of chemotherapeutics and preparation of embolism, The discovery of secondary tumors after embolization of main tumor has an important value in determining whether the operations are performed or not. The hemodynamic changes before and after TACE is valuable clinical information for designing the combined therapy of tumor.