微波凝固消融治疗原发性肝癌后对TACE的影响

The effect to transarterial chemoembolization of percutaneous microwave coagulation therapy for primary hepatic carcinoma

目的探讨微波凝固热消融治疗后对原发性肝癌血供及TACE治疗的影响。方法本组45例原发性肝癌患者因TACE治疗不满意行PMCT治疗,术后2～3月常规腹腔动脉、肠系膜上动脉造影及肝外血供探查,并对肿瘤供血动脉行超选择TACE术。结果12例患者TACE术中发现肝外供血动脉,膈下动脉6支,右肋间动脉2支,胃左动脉1支,右肾动脉1支,左右胸廓内动脉各1支;PMCT术后TACE发现新增肝外营养血管8例,分别为右膈下动脉5支,右侧下位肋间动脉2支,右肾动脉1支;对全部新生肝外血供均行超选择性插管及化疗栓塞治疗。结论PMCT可有效杀灭肝癌肿瘤细胞,但因其造成的创伤可诱导肝外新生肿瘤供血,在随后进行的肝癌介入治疗中应积极寻找新生肝外血供对提高疗效有重要意义。

Objective To discuss the effect of percutaneous microwave coagulation therapy on hepatic artery blood supply of primary hepatic carcinoma and transarterial chemoembolization.Methods 45 patients with primary hepatic carcinoma undertook percutaneous microwave coagulation therapy because of poor blood supply,large lesion or residues lesion after TACE.Two to three months after PMCT,angiography and TACE was done.Results 12 extrahepatic arteries were found during TACE,including 6 inferior phrenic arteries,2 intercastel artery,1 left gastric artery,1 right kidney artery and 2 internal thoracic arteries.There were 7 new extrahepatic arteries found after PMCT,including 5 right inferior phrenic arteries,2 right intercastel arteries and 1 right renal artery.TACE was done for these arteries.Conclusion PMCT could kill hepatic carcinoma cell effectively.But it could induce new supply blood vessel.It is very important to find out all extrahepatic arteries for increasing therapeutic effect.