介入治疗贲门癌伴肝转移24例临床观察

Cardiac Involvement in 24 Cases of Liver Metastases with the Clinical Observation

目的探讨肝固有动脉＋胃左动脉化疗栓塞术治疗贲门癌伴肝转移患者的临床应用价值。方法对24例贲门癌伴肝转移的首治患者，采用Seldinger穿刺插管技术，选取：5-Fu、ADM（EADM、THP）、DDP（L—OHP）、MMC中的2～3种灌注，胃左动脉选用明胶海绵栓塞，肝固有动脉则采用碘化油栓塞。结果第2次介入治疗4周后进行评价。除去3例仅作1次介入治疗患者，治疗后吞咽困难：0级2例、Ⅰ级6例、Ⅱ级10例、Ⅲ级2例、Ⅳ级1例；生存质量：差2例、一般4例、较好10例、良好5例；疗效评价：CR0例（0）、PR14例（58．3％）、SD7例（29．2％）、PD3例（12．5％），有效率为58．3％；生存期1、2、3、4年分别为75．0％、37．5％、12．5％、4．2％。结论对贲门癌肝转移的患者，行肝固有动脉＋胃左动脉化疗栓塞术，具有改善吞咽困难症状、提高生存质量、延长生存期、疗效相对满意、不良反应可控制、适宜人群广的优点，应推广应用于临床。

Objective To study cardiac carcinoma patients with liver metastases with hepatic artery chemotherapy ＋ left gastric artery embofization for the clinical appfication value. Methods 24 cases of cardia carcinoma with liver metastases were the first medical treatment. Cannulation using Seldinger puncture technique, select ：5-Fu, ADM （ EADM, THP）, DDP （L-OHP） , MMC infusion of 2-3 drugs. Selection of left gastric artery gelfoam embolization, hepatic artery embolization of lipiodol oil is used. Results Involved in the treatment of the second evaluation after 4 weeks. Only three cases of removal of a single intervention for the treatment of patients. Dysphagia after treatment：0 grade 2 cases, Ⅰ grade 6 cases, Ⅱ grade 10 cases, Ⅲ grade 2 cases, Ⅳ grade 1 case. Evaluation of quality of life：poor 2 cases, general 4 cases, better 10 cases, good 5 cases. Short-term efficacy： CR 0 （0） ,PR 14 cases（58.3% ） ,SD 7 cases（29.2% ） ,PD 3 cases（ 12.5% ） ,The effective rate was 58.3%. The 1-,2-,3-,4-year survival rates were 75.0% ,37.5%, 12.5% ,4.2%. Conclusion To patients with liver metastasis of gastric cardia, hepatic artery chemotherapy ＋ left gastric artery embolization can improve dysphagia symptoms,the quality of life,the survival period, adverse reactions can be controlled, and suitable for people of the advantages of wide. Clinical application should be extended.