肝细胞癌经皮穿刺肝动脉化疗栓塞缩小后切除及疗效分析

作者为探讨不能切除的肝细胞癌经肝动脉化疗栓塞（ＴＡＣＥ）缩小后行肿瘤切除的疗效,总结了５９例肝细胞癌患者的经验。本组患者首次ＴＡＣＥ前肿瘤直径５．６～２０．０ｃｍ,平均９．４３ｃｍ,每人接受ＴＡＣＥ１～６次,平均２．９次,手术前肿瘤直径缩小至３．２９ｃｍ,末次ＴＡＣＥ距手术时间１～７个月,平均２．５个月。ＡＦＰ阳性３５例,ＴＡＣＥ治疗后１３例转为正常。５９例患者中行肝段、联合肝段或肝部分切除５６例,左三叶切除２例,左半肝切除１例。切除的肿瘤各有４０％～１００％坏死,其中９例１００％坏死。ＴＡＣＥ后１３例ＡＦＰ转为正常的患者中,９例镜下仍见癌细胞。５９例患者１、３、５年生存率分别为７９．７％、６５％和５６％。作者认为ＴＡＣＥ可为一期不能切除的肝癌患者争取手术切除的机会,且可获得满意疗效。

Liver resection after transcatheter hepatic arterial chemoembolization for hepatocellular carcinoma and curative effect analysis

To study the therapeutic result of hepatic resection for those hepatocellular carcinoma (HCC) shrunked after transcatheter hepatic arterial chemoembolization (TACE) in the patients with unresectable HCC, authors reported 59 patients with HCC. Among the 59 patients, the maximum diameter of the tumor was 5.6 to 20.0 cm prior to the first TACE, mean 9.43 cm. The patients underwent 1 to 6 times of TACE, mean 2.9 times. The tumor diameters were reduced to 3.29 cm prior to operations. The duration between the last TACE treatment and sequential resection varied from 1 to 7 months, mean 2.53 months. Of the 59 patients, 35 patients' serum alpha-fetoprotein (AFP) levels were elevated. AFP levels returned to normal after TACE treatment in 13 patients. Of the patients, liver segmentectomy, combined liver segmentectomy or partial liver resection was performed in 56 patients, left trilobectomy in 2 and left hemihepatectomy in 1. Tumor necrosis ranged from 40% to 100% pathologically and complete tumor necrosis occurred in 9 patients. Of the 13 patients with AFP levels decreased to normal, 9 still had microscopic living tumor foci. The 1-, 3- and 5- year survival rates were 79.7%, 65% and 56%, respectively. These results indicated that TACE treatment can provide chance of tumor resection for those patients with unresectable HCC and good results can be obtained.