经动脉热化疗治疗肝癌的临床应用

Clinical application of transarterial thermochemotherapy for hepatic cancer

目的 研究经肝动脉灌注热化疗药治疗肝癌的有效性及安全性。方法 对３５ 例肝癌患者行肝动脉插管热化疗，碘油、５Ｆｕ 及卡铂加热至６０ ～６５°Ｃ后经导管灌入肝动脉，其余药物不加热。９例重复治疗，与同期１４ 例作２ 次或以上普通介入治疗的肝癌患者比较。４ 例热化疗后２ ～３ 个月手术切除，与同期普通介入治疗后手术切除的４ 例作比较。结果 热化疗组的肿瘤生长率为－ １０ ．０％±３３．３ ％ ，对照组的肿瘤生长率为３６ ．４％ ±５９．０％ ，差异有显著性（Ｐ＜ ０．０５） 。手术切除标本的坏死率（大体）分别为９３．５ ％ ±５ ．９７ ％ 及７３．５ ％ ±２８ ．３８ ％ ，但差异无显著性，显微镜下观表现相似。肝动脉损伤各一例。热化疗组中１９ 例行“夹心面包”疗法，与普通“夹心面包”疗法的２２ 例比较，其轻、中度毒副反应分别为７３．７％ 和６３．６％ ，重度反应为２６ ．３ ％ 和３７ ．４ ％ ，但差异无显著性。结论 经肝动脉灌注６０～６５°Ｃ的碘油、化疗药合并明胶海绵栓塞肝动脉治疗肝癌是简单、安全的方法，能显著提高单纯化疗、栓塞的疗效。

Objective To investigate the effectiveness and safety of transhepatic arterial infusion of warm chemotherapeutic agents in treating hepatic cancer. Methods 35 cases of hepatic cancer were treated with transhepatic arterial thermochemotherapy, with Lipiodol, 5 Fu and carboplatinum warmed to 60～65 °C before infusion into hepatic arteries. 9 patients had two or more treatments and the effectiveness was compared with those of 14 patients receiving simple interventional treatment within the same period. 4 patients had their tumors removed 2～3 months later and the pathological results were compared with those of 4 other patients who had ordinary interventional treatment. Results the tumor growth rate of thermochemotherpay group was -10±33.3% while that of the control group was 36.4±59.0%, showing statistically significant difference. The rates of tumor necrosis on the axial section of resected samples were 93.5±5.97% and 73.5±28.3% respectively but without statistical difference. Pathological changes of both groups were similar microscopically. Only one patient in each group had injury to the artery. Comparing 19 cases of thermochemotherapy group with 22 cases of control group all of whom received “sandwich” therapy, the rates of adverse effect of mild to moderate degree were 72.7% and 63.6%, respectively, those of severe degree were 26.3% and 37.4% , respectively, but these differences were of no statistical significances. Conclusions Transhepatic arterial perfusion of warmed Lipiodol, chemotherapeutic agents (60～65 °C ) combined with hepatic arterial embolization with gelfoam is a simple and safe method in treating hepatic cancer, which can enhance markedly the effectiveness of simple transarterial interventional therapy.