块状型肝癌动脉化疗栓塞后肿瘤门残留现象的观察和对策

The tumor hilar remnant phenomenon after TACE in massive hepatocellular carcinoma: observation and countermeasure

目的 观察、分析肝动脉化疗栓塞 (TACE)后“肿瘤门残留现象”成因 ,寻求对策。方法 162例块状型原发性肝癌患者 ,早期病例采用常规方法栓塞 (A组 ,n =84) ,后期采用“新三明治法”栓塞 (B组 ,n =78)。观察两组TACE后残留现象的发生率及中期疗效。结果 TACE治疗后即时 ,A组“残留现象”占 75 % ,B组 3 9.7% (P <0 .0 1)。 1个月后复查 ,A组“残留现象”占 82 .1% ,B组占 44 .9% (P <0 .0 1) ,其中A组有 6例、B组有 4例在第一次复查时首次出现“残留现象”。A组肝内和 /或远处转移 5 2例 ,B组 17例 (P <0 .0 1)。A组一年生存率为 62 % ,B组为 85 % (P <0 .0 1)。结论 肿瘤动脉插入式供血、肿瘤门区域血管管径粗血流速度快、相对容易形成侧支血供和常规栓塞治疗中常出现的假性完全性栓塞为“残留现象”的主要形成原因。

Objective To observe the tumor hilar remnant phenomenon (THRP) after transcatheter arterial chemoembolization (TACE), and to analyze the factors of its formation, in order to find a countermeasure of treatment. Methods There were 162 patients with primary hepatocellular carcinoma of massive type. The cases in early stage were treated by conventional TACE (Group A, n=84), and the cases in late stage treated by new sandwich TACE (Group B, n=78). After the TACE, the incident rates of THRP and the effects of therapy were compared between the two groups. Results The incident rate of THRP was 75% in Group A and 39.7% in Group B (P<0.01) just after the first time of TACE, and (82.1%) in Group A and 44.9% in Group B (P<0.01) one month later. Six patients in Group A and 4 patients in Group B who had no THRP showed this phenomenon in the first follow-up check. There were no serious complications that related to TACE. During the one-year follow-up, intra-hepatic and/or distant metastasis were found in 52 cases in Group A and 17 cases in Group B (P<0.01). The one-year survival rate was 62% in Group A and 85% in Group B (P<0.01). Conclusion The main factors of THRP formation include the inserted feeding tumor arteries, the bigger vessel diameter and the faster blood flow in the hilar area of tumor, the easier collateral blood supply, and the ”false complete TACE” which is usually to be found in conventional TACE. The new sandwich TACE can get better results than the conventional TACE because it can treat THRP effectively.