经腹肝动脉门静脉双置泵栓塞灌注化疗治疗中晚期肝癌

Treatment of unresectable hepatocellular carcinoma with embolization and chemotherapy via hepatic artery and portal vein through pumps

目的探讨提高中晚期肝癌外科治疗的有效途径。方法回顾性分析经腹肝动脉门静脉双置泵栓塞灌注化疗治疗不能手术切除的中晚期肝癌３８例的临床资料。结果肿瘤直径５～１８ｃｍ，平均９２ｃｍ，皆为多供血型。巨块型２４例，结节型８例，弥漫型６例。伴门静脉癌栓１８例。肝动脉栓塞采用４０℃的碘油和明胶海绵微粒；化疗药物采用阿霉素（ＡＤＭ），顺铂（ＤＤＰ），丝裂霉素Ｃ（ＭＭＣ）和氟脲嘧啶（５Ｆｕ）。３２例甲胎蛋白值升高者治疗后１６例降至正常。肿瘤直径平均缩小４５％。８例行二期手术切除肿瘤，其生存期均在１２个月以上，最长已达３年；未行二期手术者３０例，中位生存期为９６个月。结论经腹肝动脉门静脉双置泵栓塞灌注化疗，附加局部注射无水酒精和热电疗法，是治疗不能手术切除中晚期肝癌首选而有效的方法。

Objective To explore the effective method for treating advanced hepatocellular carcinoma (HCC). Methods Retrospective analysis was made for the clinical data of 38 patients with unresectable HCC who were treated by embolization and chemotherapy via hepatic artery and poltal vein through pumps. Results The mean diameter of the tumors was 9.2cm (ranged from 5cm to 18cm). All of the tumors had abundent blood supply. Of them, the macroscopic features of HCC were massive in 24 cases, nodular in 8 cases, diffused in 6 cases. Cancer emboli in the portal vein was found in 18 cases. The material used for artery embolization was ethiodized oil and particles of gelfoam, the drugs of chemothrapy were combination of ADM, MMC, DDP and 5 Fu. After treatment, AFP level was decreased to normal in 16 of 32 patients who had increased AFP level befor operation. The diameter of tumors was decreased by 45% on average. Eight cases underwent second resection of the tumor after this treatment method, and survived over 12 months, the longest one survived for 3 years. The median surviving time of the others, who had not undergone second resection, was 9.6 months. Conclusions Embolization and chemotherapy via hepatic artery and portal vein through pumps is an effective method for treating unresectable HCC.