经皮经肝动脉分支穿刺栓塞化疗联合高强度聚焦超声治疗肝癌的疗效评价

The efficacy of TAE combined with HIFU to treat hepatocarcinoma

目的探讨经皮经肝动脉分支穿刺栓塞化疗(TAE)联合高强度聚集超声(HIFU)治疗肝癌的疗效。方法随机选择肝癌10例,其中原发肝癌6例,转移癌4例,于肝动脉栓塞化疗后行HIFU治疗,治疗前后行MRI平扫及增强扫描以评价疗效。结果10例肝癌患者经TAE联合HIFU治疗2周后,删显示肿瘤区完全无强化,肿瘤血供阻断呈凝固性坏死者8例;2例肿瘤区周边少许强化,联合HIFU治疗后肿瘤完全无强化,肿瘤血供完全阻断。一个月后复查肿瘤缩小1／3者5例,完全坏死液化者2例,稳定无明显缩小者3例,未见肿瘤增大或扩散转移,其中1例手术切除病理证实癌细胞全部坏死。结论TAE联合HIFU治疗肝癌能有效切断肿瘤供血和侧支循环的建立,使肿瘤凝固性坏死,两方法联合应用有协同加强杀灭癌细胞作用,是微创、安全,有望达到介入性根治目的的治疗方法。

Objective To study the effect of Transcatheter Arterial Embolization（TAE）combined with High Intensity Foe.used Ultrasound （HIFU） to treat hepatocarcinoma. Methods Ten cases with hepatocareinoma were selected randomly, and there were 6 cases with primary hepatocarcinoma, 4 cases with metastasis hepatocarcinoma. After the arterial enbolism chemotherapy, HIFU treatment was performed. The MRI examination （scan and intensifier） was used to find out the effect of the treatment befom and after the treatment. Results Two weeks after TAE combining HIFU treatment, MRI examination showed that images of hepatoearcinoma in 10 cases didn＇ t intensify completely. Neoplastic bloot supply had been blocked and coagulation necrosis was detected in tumors tissue in 8 cases. Blood supply around neoplastic area in 2 cases had a little intensification. After combing HIFU treatment, the imaging of tumor didn＇t intensified completely, and the blood supply of the tumor were complete blocking in 2 cases. After a month, the reexaminations of patients showed that tumors shrunk for 1/3 in 5 cases and necrosed in 2 cases. The tumors were stable, didn＇ t shrink and augment or diffusion and transfer in 3 cases. Postoperative pathology showed that necrosis of cancer cells was complete. Conclusion The TAE combining HIFU to treat the hepatocarcinoma can block the neoplastic blood supply and the collateral circulation effectively, and make the tumor coagulation necrosis. This combined method can potentiate obliteration of cancer cells. It is minimally invasive, safe and hopeful to be a radical treatment of cancer.