小肝癌肿瘤滋养动脉超选择性无水乙醇栓塞治疗的临床价值(附95例报告)

Evalution of ultraselective transcatheter tumor feeding arterial embolization with ethanol and lipidol for small hepatocellular carcinoma (SHCC) in 95 cases

目的：回顾性评价小肝癌滋养动脉超选择性插管无水乙醇栓塞治疗的安全性、技术成功率、疗效，以探索小肝癌治疗的新途径。方法：对CT或MRI等检查发现的小肝癌或临床高度怀疑小肝癌者95例实施选择性肝动脉造影检查，经DSA证实后，以微导管对小肝癌滋养动脉行超选择性亚节段插管，并以无水乙醇＋超液态碘油（1：1）对143个病灶实施完全性充填栓塞。结果：95例共143个小肝癌病灶超选择性插管、栓塞技术成功100％，全部病例术后无严重并发症发生。术前病灶直径0．5～3cm，平均直径2．3cm；术后3月复查，肿瘤平均直径1．2cm。术后1、3、5年复发率分别为19％（18／95）、27％（26／95）、37％（35／95）。1、3、5年生存率分别为100％（95／95）、85％（81／95）、67％（64／95）。结论：小肝癌滋养动脉超选择性插管并无水乙醇栓塞治疗疗效显著、并发症发生率极低、术后复发率低于外科切除术，应作为小肝癌治疗首选方法。

Objective ：To retrospectively evaluate the safety, technical success rate, and effectiveness of nltratranscatheter tumor feeding arterial embolization with ethanol and lipidol for SHCC ,and to explore the new therapy for SHCC. Methods：To 95 eases carry out hepatic selective arterial angiography for SHCC by CT or MRI be diagnosed and clinical very doubt be SHCC,after was diagnosed by DSA,to transcatheter nhraselective subsegmental feeding artery with microcatheter for tumor, employ ethanol and lipidol （ 1/1 ） to full fill embolized 143 tumors. Results：Technical success rate was 100% for the ultraselective subsegmental feeding artery transcatheter and embolizatoin in SHCC, There were no major complications in all cases.Before embolization , the diameter of tumors were 0.5-3cm, average diameter 2.3 cm. after tumors were embolized,average diameter 1.2 cm. The 1,3and 5 year recurrence rates were 19% （18/95）,27% （26/95）,37% （ 35/95 ）, and the survival rates were 100% （ 95/95 ）, 85% （ 81/95 ）, 67% （ 64/95 ） respectively. Conclusion： Its effectiveness was very notable,there were no major complications and recurrence rates was less than surgical resection in ultraselective transcatheter tumor feeding arterial embolization with ethanol and lipidol for SHCC, It should become the first selective therapy for SHCC.