肝癌切除术中肝动脉、门静脉留置IDDS的临床意义

Role of Implanting IDDS in Hepatic Artery and Portal Vein during Tumor Resection for Patients with Liver Cancer

作者对３７例肝癌肝切除患者，在术中将全埋植式给药装置（ｉｍｐｌａｎｔａｂｌｅｄｒｕｇｄｅｌｉｖｅｒｙｓｙｓｔｅｍ，ＩＤＤＳ）留置于肝动脉和门静脉，以探讨术后定期肝动脉、门静脉造影和化疗对复发的监测、预防和治疗价值。１）造影发现ＣＴ漏诊的亚临床期肝复发癌１例；２）２２例单纯肝切除及３７例肝切除加定期肝动脉、门静脉化疗患者，其１年复发率分别为５４．５％及２４．３％（Ｐ＜０．０５），２年复发率分别为７７．３％及３７．８％（Ｐ＜０．０１）；３）６例肝内广泛复发患者，经肝动脉、门静脉化疗后，２例肿瘤缩小，４例血清ＡＦＰ下降，复发后中位生存期５个月。提示肝癌切除术中肝动脉、门静脉留置ＩＤＤＳ，对于术后复发的监测、预防和治疗。

To study the role of implantable drug delivery system (IDDS) linking with hepatic artery and portal vein during cancer resection for surveillance, prevention and treatment of recurrence of liver cancer.Intraoperative hepatic artery and portal vein catheterization were performed on 37 patients with liver cancer and it was connected to IDDS implanted under the skin of the abdomen wall. Periodic hepatography and chemotherapy were done through hepatic artery and portal vein by way of IDDS.(1)Recurrence was found by hepatography in one patient with negative CT finding. (2) The 1, 2year recurrent rates of 22 cases of liver cancer who underwent simple hepatectomy and 37 cases treated with hepatectomy and periodic chemotherapy through IDDS were 54.5%,24.3% (P<0.05) and 77.3%, 37.8% (P<0.01) respectively. (3) In 6 cases of wide spread cancer recurrence after IDDS chemotherapy, it was found that tumor was reduced in size in 2 cases, drop of serum AFP was noted in 4 cases and that the median survival time of the patients with recurrence was 5 months.It is suggested that introperative implanting IDDS is helpful in surveillance for recurrence of liver cancer.