栓塞微球在肝癌介入治疗中的应用

Application of trisacryl gelatin microspheres in the interventional treatment of hepatic carcinoma

目的评价栓塞微球对肝癌的栓塞性能,观察经导管栓塞治疗肝癌的近期疗效与不良反应。方法选择23例(34个病灶)原发性肝癌患者,经股动脉插管至肿瘤供血动脉,注射半量化疗药物及碘油3～5ml后将栓塞微球0.5～6ml混入适量对比剂透视下注入,至血流明显减慢或血管铸型时停止。每隔1个月复查肝脏增强CT或MRI、血清AFP。如病灶仍有强化或新生病灶、AFP继续增高者重复治疗。观察临床疗效与不良反应。结果全组无CR,PR9例,NC13例,PD1例。有效率(CR+PR)为39.1%,获益率(CR+PR+NC)为95.7%。28/34枚血供丰富、强化明显的病灶中首次治疗后有17枚有残余强化,另11枚病灶完全栓塞。17枚有残余强化的病灶中,10枚病灶重复治疗,其中3枚获完全栓塞。11枚完全栓塞的病灶在2～9个月的随访中,4枚再次出现残余强化,2枚重复治疗后均获完全栓塞。AFP阳性的18例患者中,11例明显降低,6例无明显变化,1例明显升高。术后观察5～14d,发热18例,肝区疼痛11例,恶心呕吐6例,ALT较术前明显升高2例,BIL明显升高1例,WBC均无变化。结论栓塞微球经导管注射治疗肝癌,栓塞性能优越,临床疗效确切,不良反应少,是一种优良的肿瘤栓塞剂。

Objective To evaluate the embolization efficiency, short term clinical effect and adverse reactions of trisacryl gelatin microspheres in interventional treatment of hepatic carcinoma. Methods Twenty three cases of hepatic carcinoma （34 foci）were given 0.5-6 ml of microspheres mixed with some contrast medium via catheter after injection of chemodrugs and lipiodol 3-5 ml; and simultaneously observing the appearance of slow down of blood flow and vascular cast formation to stop the procedure. Enhanced CT or MR and AFP were performed every 1 month after the first procedure. Treatment needed to be repeated whenever the foci or new ones were enhanced in CT scans or increase of AFP value. The clinical effect and adverse reactions were also observed. Results The positive response rate was 39.1% （CR＋PR）. There were 9 cases of PR, 13 cases of NC and 1 of PD ; but no case of CR. Residual enhancement was observed in 17 foci after first procedure, 10 of which received repeated therapy and 3 were embolized completely. The other 11 foci were completely embolized, among them 4 had new residual enhancement during 4-9 mo follow up and 2 were re-embolized completely. Eighteen cases with positive AFP showed obvious decrease in 11, no change in 6 and increase in one. Eighteen cases of pyrexia, 11 cases of pain in hepatic region and 6 cases of nausea occurred 5-14 d after the procedure together with vomiting. We also found increase of ALT in 2 cases, BIL of 1 case, and no change of WBC in all cases. Conclusion Trisacryl gelatin microspheres is an excellent embolization agent with better clinical effect and less adverse reaction in the treatment of hepatic carcinoma.