B超引导经皮介入光动力治疗中晚期肝癌30例

为探讨治疗中晚期肝癌的理想方法，扩大和发展光动力疗法，自１９９４年６月起，我们应用光动力疗法（ＰＤＴ）治疗中晚期肝癌３０例，其中肝细胞癌２８例、腺癌２例。肿瘤直径７～１０ｃｍ的１３例、１０ｃｍ以上至１６ｃｍ的１７例。伴肺转移５例、骨转移５例、门静脉或腔静脉浸润４例。首次治疗１９例、其他方法治疗无效或复发者１１例。本研究采用氩激光泵浦染料激光器系统，获得６３０ｎｍ波长的连续波治疗光。光敏剂选用血卟啉衍生物（ＨｐＤ）。治疗时通过Ｂ超引导经皮肝穿，将光纤导入肿瘤组织中布点照射。治疗后未见肝功能明显损伤，未出现肝穿出血、腹膜炎等严重并发症，没有一个月内病情恶化者。有１４例患者只作一次治疗，其中５例出院后失访；另９例肿瘤部分缓解率为２２％。１６例患者接受二、三次治疗，肿瘤部分缓解率达到６２％。随访病例中有８例已存活１年以上。

Ultrasound Guided Percutaneous PDT for Advanced Liver Cancer A Report of 30 Cases

patients with advanced liver cancer were treated by interstitial photodynamic therapy (PDT). These included 28 hepatocellular carcinoma and two adenocarcinoma, 19 primary tumors and 11 recurred following other treatments. The diameter of tumors were 7 10 cm in 13 cases and 10 16 cm in 17 cases. In this study, an argon laser pumped dye laser system was used to give a CW laser beam at 630 nm which was split and coupled into three optical fibers. The patients received injection of photosensitizer of hematoporphyrin derivative (HpD) i.v. at a dose of 5 mg/kg body weight 48 h prior to laser irradiation. Then the fibers were inserted into tumor by ultrasonic visualization guided percutaneous liver puncture. The inserted irradiation points were spaced in entire tumor volume and the tumor was irradiated with a light output power of 300 mW for 12 minuts per point. Totally 52 treatments were performed in 30 patients. Among them, 14 cases were treated by only one time and 16 cases 2 or 3 times. The follow up were carried out in 25 cases for 3 18 months. The results show that significant remission was 22% (2/9) in those patients by only one treatment and 62% (10/16) in those by 2 or 3 treatments. The reduction rate of tumor size was over 90% in five out of six cases after 3 treatments. 8 patients have been surviving over one year. No obvious change was found in all patients examined by liver function test, renal function test and blood routine examination. The level of AFP depicted a descending tendency after PDT. Our findings indicate that PDT is effective and safe for the treatment of large liver cancers including those recurred following hepatic resection and those failed in hepatic artery infusion embolic chemotherapy.