60例CT引导下化学消融治疗肝脏恶性肿瘤的技术探讨

The technical taproot of CT-guided percutaneous ethanol injection therapy for the treatment of liver carcinoma in sixty patients

目的:探讨CT引导下化学消融(PEI)治疗肝癌的一些技术细节问题。方法:对45例原发性肝癌(含小肝癌9例),15例转移性肝癌,共计92个瘤体,CT引导下化学消融治疗116次(其中对8例膈下肝癌采用经皮-肺-膈肌途径化学消融)。结果:AFP降至正常者15例;AFP不同程度下降者21例;AFP未下降或上升者9例。在术后3个月经超声CDFI随访的92个瘤体中,51个经治瘤体表现为CDFI血流信号消失,41例表现为肿瘤类或周边点状血流信号;结合同期其他影像学检查评价,35个经治瘤体缩小;45个经治瘤体停止增长,12例肿瘤周边复发或出现新的转移灶。在肿瘤基质纤维化不明显的条件下,使用三测孔笔尖式注射针,与斜面穿刺针相比无优势。结论:PEI技术使用中,无水乙醇弥散程度与TACE后肿瘤坏死程度正相关,与肿瘤本身纤维化的程度负相关;肿瘤基质纤维化程度重则不推荐PEI。多普勒CDFI靶区血流信号评价对PEI重点消融部位的判断和治疗方式的选择有一定的参考价值。

Objective：To study some technical taproot of Percutaneous ethanol injection therapy for the treatment of liver carcinoma by CT. Methods：There were 45 primary hepatic carcinoma （including 9 small hepatic carcinoma）,15 metastatic hepatic carcinoma,and these hepatic carcinoma had 92 tumor.The number of treating them in PEI by CT was 116（including 8 subphrenic hepatic carcinoma＇s treating through skin-pulmo-diaphragm in PEI）. Results：There were 15 hepatic carcinoma patients whose AFP got normal;21 patients whose AFP were descent;9 patients whose AFP were not descent or ascending.By CDFI of supersonic after three months,51 of all the 92 tumors had no CDFI blood signal, 41 cases shew spot blood signal; 35 tumor body got smaller;45 tumor stop growthing. 12 cases recrudesced or shew new metastasis. We found there were significant indifference comparing to Hakko sonoguide PEI needle treaty with Chipa needle treaty if the hepatic carcinoma fibrosis was not significant. Conclusion：The disseminated of absolute ethanol is positive correlation to the level of tumor necrosis after TACE,and is negative correlation to the level of hepatic carcinoma fibrosis in PEI.The way of PEI is not recommended if the hepatic carcinoma fibrosis is severity.The blood signal of CDFI is significant to the judging of PEI and the selecting of way of hepatic carcinoma treaty.