无水乙醇瘤内注射治疗

Percutaneous Ethanol Injection Therapy for Liver Carcinoma

目的：分析肝癌患者瘤内无水乙醇注射治疗（ＰＥＩＴ）疗效的影响因素，完善治疗技术。方法：１９９０～１９９５年，２３８例肝癌在超声引导下行瘤内无水乙醇行多点注射，包括肿瘤中央、周边及紧贴包膜外，至整个肿瘤均匀增强，每次注射１～２０ｍｌ，每周注射１～２次。结果：（１）无水乙醇注射即时，局部回声明显增强，稍后增强回声消退，消退速度与治疗次数有关。紧贴肿瘤包膜外注射时，回声呈环状增强。穿刺针穿入肿瘤的供应血管和引流血管时，局部回声改变不同。原肿瘤区的复发病灶，再次ＰＥＩＴ治疗时，乙醇常扩散困难；（２）病理显示癌细胞大部坏死，呈梯度改变，中央明显，外周坏死、变性相间。残留癌细胞周边多见，尤以大血管周围多见；（３）８例肿瘤原位复发快速增殖。结论：了解影响ＰＥＩＴ疗效因素，使用完善的治疗技术，定期随访，可产生良好的治疗效果。

PURPOSE:To analyze factors that affect percutaneous ethanol injection therapy (PEIT),in order to improve PEIT technology.METHODS:During 1990～1995,PEIT have been performed on 238 cases of liver carcinoma. Multi-point injection including center, peripheral and around the peri-capsule of tumor were accomplished, until the whole tumor was hyperechoic. 1～20 ml each time and 1～2 times per week.RESULTS:(1)Tumor became hyperechoic when injection was being done. Some time later, echo faded. The time echo diminished was relevant to the times of therapy. When injected around pericapsule, echo enhancement was ring-like. When puncture needle was in different vessels (proliferate or drainage vessels),the echo change was different. For lesions of tumor recurrence in site, ethanol diffusion was difficult.(2)Pathology show most tumor cells underwent necrosis. Necrosis was prominent in the center. Degeneration alternated with necrosis in the periphcry. Undamaged tumor cells were invariably around circumference of the lesion, especially near large vessels.(3)There were 8 cases having tumor recurrence in site and rapid growth. CONCLUSION:Understanding factors that affect PEIT and follow-up at regular intervals would be beneficial to improve curative effect of liver carcinoma