经导管化疗栓塞治疗单发性肝细胞癌的疗效分析

Efficacy of Transcatheter Chemoembolization forTreatment of Single Hepatocellular Carcinoma

目的 研究经肝动脉导管化疗栓塞（TACE）治疗肝硬化伴有单发的原发性肝癌（不适合外科手术切除和经皮射频消融治疗）的有效性。方法 回顾176例进行过TACE治疗的持续性肝硬化伴有单发性肝癌的患者。TACE是使用表阿霉素配制的剂量是50mg/m2,在30min内用注射器推注,然后使用碘油和明胶海绵进行栓塞。结果 患者总共接受了368次TACE的治疗平均（2.4±1.7）次。94名患者（58%）获得完全性肿瘤坏死,16名患者（10%）出现大部分坏死（90%～99%）,18名患者（11%）获得部分性坏死（50%～89%）,有34名患者（21%）肿瘤病灶很少坏死（〈50%）。根据原发性肝癌癌灶大小等级,癌灶获得完全坏死的比例也不同,分别是69%,69%,52%,68%,50%和13%,相应的癌灶大小为,≤2.0,2.1～3.0,3.1～4.0,4.1～5.0,5.1～6.0,〉6.0cm。癌灶大小分别为：≤2.0,2.1～3.0,3.1～4.0,4.1～5.0,5.1～6.0,〉6.0cm的患者,Kap-lan-Mayer24个月生存率分别是88%,68%,59%,59%,45%,53%。结论 肝硬化患者中,伴有癌灶小于6.0cm的单发性原发性肝癌的患者,通过TACE治疗能对大部分患者的肿瘤产生局部控制的作用。因此,对于不能外科手术治疗或是经皮消融治疗的单发性原发性肝癌患者来说,TACE是一种有效的治疗选择。

Objective To investigate the efficacy of transcatheter chemoembolization （TACE） in cirrhotic patients with single hepatocellular carcinoma （ HCC ） not suitable for surgical resection and percutaneous ablation therapy. Methods A total of 176 consecutive cirrhotic patients with single HCC undergoing TACE was reviewed; TACE was performed with Farmorubicin prepared in sterile drip at a dose of 50 mg/m^2, infused over 30 rain using a peristaltic pump, and followed by Lipiodol and Gelfoam embolization. Results Patients received a total of 368 TACE （ mean 2.4 ± 1.7 ）. Complete tumor necrosis was obtained in 94 patients （58%）, massive （90% -99% ） necrosis in 16 patients （10%）, partial （50% -89% ） necrosis in 18 patients （11%） and poor （ 〈50% ） necrosis in the remaining 34 patients （21%）. The rate of complete necrosis according to the HCC size class was： 69%, 69%, 52%, 68%, 50% and 13% for lesions of ≤ 2.0, 2. 1 -3.0, 3.1 -4.0, 4. 1 -5.0, 5.1 - 6. 0, and 〉 6. 0cm, respectively. Kaplan - Mayer survival at 24 - month was 88% , 68% , 59%,59%, 45%, and53% for lesions of≤2.0, 2.1 -3.0, 3.1 -4.0, 4.1 -5.0, 5.1 -6.0, and 〉 6. 0 cm, respectively. Conclusion Our study showed that in cirrhotic patients with single HCC smaller than 6. 0 cm, TACE produces complete local control of tumor in a significant proportion of pa- tients. TACE is an effective therapeutic option in patients with single HCC not suitable for surgical resection or percutaneous ablation therapies.