TACE、PEI、PVC介入三联疗法治疗中晚期肝癌

Combination Treatment of Transcatheter Arterial Chemoemboization, Percutaneous Ethanol Injection with Portal Vein Chemotherapy in Advanced Liver Cancer

目的研究TACE、PEI、PVC介入三联疗法治疗原发性肝癌的疗效。方法(1)TACESeldinger′s法,5F导管、高选择、造影到位后注入5Fu1g、MMC10mg、ADM或EADM50～60mg与40%碘化油10～20mL的混合乳化剂。隔1～1.5月可重复;(2)PEICT引导下18GPTC穿剌针穿入肿瘤碘油缺损区,注入无水酒精2～8mL或10～20mL,1～2次/周,4～6次为1疗程;(3)PVCPEI后1～2周,在B超引导下用18G中心静脉导管穿剌针到门静脉穿剌,留置中心静脉导管或植入药盒,1次注入MMC6～8mg,药泵持续5d灌注5Fu2.5～3g。可隔3～4周后重复给药。结果本组14例,病灶缩小率为71.4%,AFP下降占85.7%;半年生存率为78.6%,1年生存率为57.1%,2年生存率为28.6%。结论介入三联疗法对不能手术切除,尤其对门静脉癌栓或门静脉供血的肝癌有较好的疗效,具优势互补作用。

Objective：To study the curative effects of transcatheter hepatic arterial cheombolization （TACE）, percutaneous ethanol injection （PEI）, and portal vein chemotherapy （PVC） on advanced liver cancer. Methods： （1） TACE Seldinger＇s intervention, 5-F# RH catheter, high selection, constract followed by infusing 5-Fu 1.0, MMC 10 mg ,ADM or EADM 50～60 mg which was emulsificated with lipiodol 20～30 ml . repeated every 1 ～1. 5 months. （2） PEI 18G PTC puncture into the liver mass where lipiodol was＇t exisl, and 2～8ml or 10～20 ml ethanol was injected. 1～2 times every week and 4～6 times for a course. （3）PVC 1～2 weeks after PEI, under the guiding by B-ultrasound, 18 G PTC puncture into the portal vein, and then central venous catheter was left into the portal vein or the medicine box was implanted, Every time 6～8 mg MMC was infused and 2.5～3 g 5-Fu was infused for 5 days protractively. Repeated every 3～4 weeks. Results： In 14 patients the tumor shrinking rate was 71.4%. AFP decline rate was 85. 7%. the 6 months, 1-, and 〉2-years survival rates was 78.6%,57. 1% and 28. 36%. Conclusion： The results indicated that the treatment of combined TACE, PEI and PVC is an effective method for patients with advanced liver cancer, especially for the palients with unresectable ad vanced one complicated with portal vein tumor thrombus.