摘要
目的:探讨肝动脉造影和肝动脉栓塞术在防治肝癌切除术后残癌的应用价值。方法:在原发性肝癌切除术后的2mo,对69例原发性肝癌切除术后患者(其中根治性性手术51例、姑息性手术18例)进行肝动脉造影和肝动脉栓塞化疗,比较了肝动脉造影和B超在诊断术后残癌的敏感性,观察了肝动脉栓塞化疗治疗残癌的临床效果。结果:69例原发性肝癌切除术后患者中发现残癌26例,其中姑息性手术者残癌的发生率为100％(18/18),根治性手术者15.7％(8/51)。残癌的平均直径为2..71±2.16cm,直径≤1cm占23.1％(6/26),≤2cm为65.4％(17/26),但多为多发性,占69.2％(18/26)。比较同期的B超和肝动脉造影发现残癌的敏感性,B超阳性者占38.5％(10/26),肝动脉造影阳性者占92.0％(23/25),肝动脉造影敏感性高于B超(p<0.005)。26例残癌经肝动脉栓塞化疗,其1a,2a生存率分别为90.0％和78.0％。结论:肝动脉造影能够早期发现术后残癌,原发性肝癌切除术后有残癌倾向者,特别是姑息性手术者应进行肝动脉栓塞化疗。
Object: For early diagnosis and treatment of residual cancer, postoperative angiography and transcatheter arterial chemoembolization (TACE) were employed in the patients underwent hepatocellular carcinoma resection. Method: In 69 after hepa-tocellular carcinoma resectin( composed of 15 wit radical resetion and 18 with palliative resection) angiography and chemoembolization were performed around 2 months after hepatectomy, the sensitivity of angiography was compared with ultrasonography and the promising effect of TACE for the residual cancer were observed. Result: The residual cancer was found in 15.7 % (8/51) of patients with radical resection and 100 % (18/18) of that with palliative resection 23.1 % (6/26) and 65.4 % (17/26) of the residual cancer with the diameter were less than 1 cm and 2 cm, respectively. The sensitivity of angiography was 92.0 % (23/25) as compared with 38.5 % (10/26) of ultrasonography in detection of the residual cancer with significant difference (P< 0. 005). The 1 and 2 years survival rates of the patient with hepatic residual cancer treated by TACE was 92.31 % and 84.29 % , respectively. Conclusion: angiography was sensitive for early detection of hepatic residual cancer in the patients after hepatectomy of HCC and TACE should be used in the patients with high risk of hepatic residual cancer, especially in the patients who underwent palliative resection of hepatocellular carcinoma.
