超声引导无水乙醇量化治疗746例肝癌远期疗效观察

Later effects of ultrasound-guided percutaneous quantified absolute ethanol injection for treatment of hepatic carcinoma

目的评价超声引导无水乙醇量化治疗肝癌的远期疗效及其术后随访的重要性。方法对病理证实的原发性肝癌746例行超声引导无水乙醇量化治疗,2～3d注射1次,4～10次为1个疗程。对伴有门静脉分支内瘤栓的病例同时行栓子内无水乙醇注射治疗,对显示清楚扩张肝动脉者同时行门静脉栓子与肝动脉穿刺(双介入)注射无水乙醇治疗瘤栓。统计1～8年生存率,肝内原位与异位复发率及复发次数。结果746例患者的1、3、5及8年生存率分别为93.7%,73.8%,53.1%和47.6%;直径≤3cm肿瘤患者的1、3、5及8年生存率明显高于直径3～5cm肿瘤患者(P<0.01)。肝癌原位及异位复发率:746例患者1、2、3、5及8年原位复发率分别为2.5%,5.7%,6.4%,8.1%和8.9%,异位复发率分别为11.4%,32.6%,47.2%,65.8%和81.9%,总的复发人次为896次。直径≤3cm肿瘤患者的1、2、3、5及8年原位复发率及异位复发率显著低于直径3～5cm肿瘤患者(P<0.01)。87例于治疗后行超声造影检查结果显示:仅8例(肿瘤直径均>3cm)于量化治疗后1个月至2年内复查结节内见小片区域轻微增强,再次行量化治疗1个月后复查未见增强,余79例病灶均未见增强。治疗后AFP转阴者(降至20ng/ml以下)占82.9%(422/509)。结论超声介入无水乙醇量化治疗肝癌远期疗效显著,可明显提高肝癌患者的生存率,延长患者生命。量化治疗后规范随访对提高肝癌的整体治疗效果有极为重要的作用。

Objective To evaluate the later effects of ultrasound-guided percutaneous quantified absolute ethanol injection （PQEI） for the treatment of 746 cases with hepatic carcinoma and the significance of follow-up after PQEI. Methods The pathologically proved hepatic carcinoma in 746 cases were treated with PQEI every 2-3 days and 4-10 times per treatment course. Absolute ethanol was also injected into portal vein with tumor thrombi and hepatic arteries. The survival rates of 1-8 years, the recurrence rates in situ as well as in ectopia and recurrence times were calculated. Results The survival rates of 1, 3, 5, 8 years in 746 cases with hepatic carcinoma were 93.7% ,73.8% , 53.1% and 47.6% ,respectively. The survival rates of 1, 3, 5, 8 years in the cases with hepatic carcinoma~〈3cm in diameter were markedly higher than those of the carcinoma 〉 3era in diameter （P 〈 0.01 ）. The 1, 2, 3, 5 and 8 year recurrence ＇rates in situ in 746 cases were 2.5% , 5.7% , 6.4% , 8.1% and 8.9% ,respectively. The 1, 2, 3, 5 and 8 year recurrence rates in ectopia of 746 cases were 11.4%, 32.6%, 47.2%, 65.8% and 81.9%, respectively. The total recurrence person-times were 896. The recurrence rates in situ and in ectopia of the tumors ≤3 cm in diameter were apparently lower than those of the tumors 〉 3cm in diameter （P 〈 0.01 ）. Results of ultrasound contrast examination 1 month to 2 years after PQEI in 87 cases showed that only in 8 tumors 〉 3 cm in diameter had slight enhancement in few sites or no enhancement was found 1 month after one repearted PQEI had course. Seventy-nine in 87 cases showed no enhancement. AFP became negative after PQEI in 82.9% （422/509） cases. Conclusions PQEI has significant later effects on improving the survival rate of hepatic carcinoma patients to prolong patients＇ life. Standard follow-up after PQEI is of importance in improving holistic treatment efficacy on hepatic carcinoma.