暂时闭塞肝静脉行肝动脉化疗栓塞治疗原发性肝癌时5-FU的血药浓度比较研究

目的研究暂时闭塞肝静脉行肝动脉化疗栓塞(TACE-THVO)治疗原发性肝癌时5-FU血浆药物浓度的变化,探讨肝TACE-THVO的适应证.方法20例原发性肝癌行TACE-THVO术.其中巨块型肝癌5例,结节型肝癌10例,弥漫型肝癌5例.肿瘤局限于肝右叶15例,跨叶或弥漫生长5例,肝动-静脉瘘5例.采用高效液相色谱法测定肝右静脉、肝静脉人下腔静脉口处、外周静脉5-FU血浆药物浓度.结果肝右静脉血浆5-FU平均血药浓度明显高于其它两个部位的血药浓度,且持续时间长.肿瘤局限于肝右叶者肝右静脉药物高浓度的平均持续时间为15 min,肿瘤跨叶或弥漫生长者为7min.肝癌不伴肝动-静脉瘘者平均持续时间为14min,有动-静脉瘘者为5min.结论肝TACE-THVO术能明显提高肿瘤局部5-FU的血药浓度,延长5-FU的作用时间,增强其抗肿瘤疗效.它的最佳适应症是局限于一叶的肝肿瘤.

A Comparative Study of 5-FU Concentration in Transcatheter Arterial Chemoembolization with Temporary Hepatic Venous Occlusion in Primary Liver Cancer (PLC)

Objective: To study the change of the plasma concentration of 5-FU in primary liver cancer treated by transcatheter arterial chemoembolization with temporary hepatic venous occlusion (TACE-THVO), and the indication of TACE-THVO. Methods: 20 patients with different types primary hepatic cancer (PLC) were treated by TACE-THVO, 5 patients with massive-type tumor, 10 patients with nodular-type tumor, 5 with diffuse-type tumor. 15 patients with tumor located in the right hepatic lobe, 5 with diffuse tumor or invaded two lobes, 5 patients with hepatoarterio-venous shunting. The high performance liquid chromatograph (HPLC) was employed to measured the plasma concentration of 5-FU in the right hepatic vein, the entrance of the hepatic veins coming into inferior venae cava and the peripherial vein. Results: The average plasma concentration of 5-FU in right hepatic vein was higher than that in the other two locations and the duration of high concentration of 5-FU was longer. The average time for the high concentration of 5-FU in right hepatic vein was 15 minutes in patients with tumor located in the right hepatic lobe, and 7 minutes in patients with diffuse tumor or invaded two lobes. The time in patients without hepatoarterio-venous shunting was 14 minutes versus 5 minutes in patients with hepatoarterio - venous shunting. Conclusion: TACE-THVO can markedly increase the drug concentration of 5-FU within the tumor area, prolong its effective time and enchance its antitumor effectiveness. The best indication of TACE-THVO is tumor located in single hepatic lobe.