CT导向下原发性肝癌肺转移瘤内注射无水乙醇的疗效评价

Efficacy of CT-guided Intra-tumoral Dehydrated Ethanol Injection on Lung Metastasis from Liver Cancer

背景与目的:肺是肝癌肝外转移最常见的器官,对于原发灶控制稳定而仅有肺转移瘤的肝癌患者,转移瘤的治疗效果就成为决定预后的关键因素。本研究通过CT导向下无水乙醇瘤内注射治疗原发性肝癌肺转移瘤的疗效评估其临床价值。方法:2004年8月至2006年9月,在CT导向下对17例原发性肝癌术后或原发性肝癌TACE术后原发灶控制稳定的肺转移瘤患者的37个肺转移灶行经皮经肺瘤内无水乙醇注射治疗,8周后复查胸腹部CT评估其临床疗效。结果:胸腹部CT复查显示,37个肺内转移灶中31个病灶无增大,增强扫描病灶无强化,其中26个病灶瘤内无水乙醇沉积完全,5个病灶沉积良好;6个病灶复查见肿瘤增大或无水乙醇明显流失,增强后有明显强化。所有患者肝内未见复发或原发灶仍维持稳定。术后8周疗效评价有效率达到83.8%,1年生存率64.2%,有7例患者至今仍生存,最长者生存超过2年。仅2例患者术中发生气胸,肺压缩均在30%以内,经施行气胸引流后3天肺组织就完全复张,未发生其他并发症。结论:CT导向下无水乙醇瘤内注射治疗肝癌肺转移瘤创伤小、疗效确切、并发症少,值得临床推广应用。

BACKGROUND ＆ OBJECTIVE： Lung is the most common organ to which liver cancer cells transfer. For the patients only with lung metastases whose primary liver cancers were in good control, treatment efficacy on lung metastasis is a crucial prognosis factor. This study was to evaluate the efficacy of CT-guided intra-tumoral dehydrated ethanol injection on lung metastasis from liver cancer. METHODS： From Aug. 2004 to Sep. 2006, 17 patients with 37 lung metastatic lesions, whose primary liver cancers were in good control after operation or transcatheter artery chemoembolization （TACE）, received CT-guided intra-tumoral dehydrated ethanol injection at Cancer Center of Sun Yat-sen University. Chest and abdominal CT scan was applied to evaluate clinical efficacy at 8 weeks after the procedure. RESULTS： On the chest and abdominal CT scan images of the 37 lesions, 31 showed no enlargement and no enhancement, with ethanol deposited completely in 26 lesions and ethanol deposited well in 5 lesions; 6 lesions showed enlargement or obvious ethanol loss, with enhancement on contrast CT scan image. All primary liver cancers were in good control during follow-up. The effective rate was 83.8%. The 1-year survival rate was 64.2%. Seven patients were still alive; the longest survival time was more than 2 years. Pneumothorax appeared in 2 patients with lung compressed by less than 30% and self restored 3 days after pneumothorax drainage procedure. No other severe complications were seen. CONCLUSION： CT-guided intra-tumoral dehydrated ethanol injection in treating lung metastasis from liver cancer is an effective, micro-invasive method with few complications.