经肝动脉联合经皮经肝选择性门静脉栓塞化学药物治疗中晚期原发性肝癌65例体会

Treatment of middle and advanced stage primary hepatic carcinoma with transcatheter artery chemoembolization plus percutaneous selective portal vein embolization

目的探讨肝动脉联合选择性门静脉栓塞化学药物治疗（ＴＡＥ＋ＳＰＶＥ）对中晚期原发性肝癌治疗效果。方法自１９９２年６月至１９９７年１２月对不能手术的中晚期肝癌６５例在ＴＡＥ术后１～２周，行超声引导下经皮经肝实质穿刺选择性门静脉栓塞化学药物治疗。结果ＴＡＥ加ＳＰＶＥ组６５例共行ＴＡＥ２７８次，平均４３次／人，ＳＰＶＥ２２５次，平均３５次／人。治疗后ＴＡＥ加ＳＰＶＥ组癌灶缩小率为９５％（６１／６５），门静脉癌栓消失和缩小率６８％（２６／３８），ＡＦＰ转阴率８１％（３８／４７），均高于单纯ＴＡＥ组８６％（４５／５２），３０％（８／２７）和６７％（２６／３９）。ＴＡＥ加ＳＰＶＥ组１，３年生存率为７４％（４８／６５）和２０％（１２／６５），单纯ＴＡＥ组则分别为６０％（３１／５２）和１０％（５／５２），两者差异有显著意义（Ｐ＜００５）。结论ＴＡＥ加ＳＰＶＥ是提高中晚期肝癌治疗效果的有效手段。

Objective To evaluate the effect of transcatheter artery chemoembolization (TAE) plus selective portal vein embolization (SPVE) on 65 patients with unresectable middle and advanced stage primary hepatic carcinoma.Results were compared with that in 52 patients with comparable clinical conditions who received only TAE.Methods From June 1992～Dec. 1997 patients with unresectable hepatic carcinoma underwent SPVE treatment under the guidance of ultrasound 1～2 weeks after TAE treatment.Results Sixty five patients underwent TAE totalling for 278 sessions,4 3 sessions per person, and SPVE treatment 225 sessions,3 46 sessions per person.The rates of tumor shrinkage,disappearance or shrinkage of portal thrombosis,and AFP negative reversion were 95% (61/65),68% (26/38) and 81% (38/47)in TAE+SPVE group,being higher than that in TAE group of 52 patients (86%,30%,67%).The 1- and 3-year survival rates for TAE+ SPVE group were 74%(48/65) and 20% (12/65),while that in group treated with TAE were 60%(31/52) and 10%(5/52) respectively. There was significant difference between the two groups in survival rates ( P <0 05). Conclusions The results showed that TAE plus SPVE is a very effective way for the treatment of middle and advanced stage primary hepatic carcinoma.