肝穿刺热消融术后肝动脉化疗栓塞术治疗原发性肝癌患者的临床意义

目的 探讨原发性肝癌热消融术治疗后的造影表现及评价其疗效,随访血管造影的临床意义.方法 选择48例原发性肝癌患者,均为单发病灶;肿瘤直径3.0～6.5 cm,平均4.4 cm,所有患者行经皮肝穿刺热消融术治疗,术后1～3个月内进行肝总动脉及可疑区域供血动脉超选择性造影,同时对残留及复发灶进行化疗栓塞术（TACE）治疗.结果 肝动脉血流改变表现：热消融治疗的肿瘤治疗区多为圆形或类圆形无染色的无血管区、低密度染色区;治疗边缘区可见肉芽染色、边缘区出血、边缘残留或复发.48例原发性肝癌患者造影发现原位边缘复发和（或）肝内异位复发灶32例,且全部完成栓塞治疗.结论 热消融区多为无染色的无或少血管区,发现和鉴别热消融治疗区域的边缘征象是判断局部残留及复发的关键.肝动脉造影及栓塞术在疗效观察及进一步综合治疗中有较高的临床价值.

Clinical significance of transcatheter arterial chemoemboliztion in preliminary hepatic carcinoma after transhepatic thermal ablation

Objective To explore the therapeutic effect of digital subtraction angiography （DSA） after transhepatic thermal ablation of preliminary hepatic carcinoma and the curative effect of ablation, and to follow up the clinical significance of DSA. Methods There were a total of 48 cases of primary hepatic carcinoma with single tumor, and the diameter of tumor was from 3.0- 6.5 em with the average of 4.4 cm. All patients were with percutaneous transhepatic thermal ablation. The super selective DSA was conducted to common hepatic artery or feeding artery of suspicious areas within 1-3 months after transhepatic thermal ablation, and transhepatic arterial chemotherapy and embolization（TACE ） was adopted for treatment on residual tumors and recurrent tumors simultaneously. Results Blood flow changes of the hepatic artery showed that tumors treated by thermal ablation were mostly in avascular areas without chromosome and staining areas with low density round or similar round;the marginal areas of treatment could be observed of granulation dyeing, hemorrhage and residual or recurrent tumors. Among the 48 patients, marginal recurrence in situ and recurrent tumors of intrahepatie eetopic appeared in 32 cases by DSA, all of which completed the treatment of TACE. Conclusion Thermal ablation areas are most in achromosomal areas with no or little vascular. To find and identify the edge signs in thermal ablation areas is critical to judge local residual and recurrence. Hepatic angiography and embolization have higher clinical value for curative effect observation and further comprehensive treatment.