介入治疗中晚期肝癌中碘油用量的分析

Amount of Iodized Oil in Interventional Treatment of Middle and Late Stage Hepatic Cancer

目的探讨介入治疗中晚期肝癌中碘油的用量。方法将64例中晚期肝癌患者按随机数字表法分为2组：A组28例和B组36例。A组患者采用肝固有动脉化疗栓塞术治疗：采用局部麻醉,在大C臂机下将5F肝管推送至肝固有动脉。先将注射用盐酸多柔比星40 mg、注射用顺铂50 mg、氟尿嘧啶1 000 mg在透视下经5F肝管缓慢注入;再将注射用盐酸多柔比星20 mg与40%超液化碘油10~20 mL充分混匀,配制成混合液20 mL,在透视下经5F肝管缓慢注入;最后将10 mL的明胶海绵微粒在透视下经5F肝管缓慢注入,术毕。B组采用超选择性动脉化疗栓塞术治疗：在大C臂机下将3F微导管超选择至肿瘤滋养动脉后,在透视下经3F微导管注入药物,同A组;碘油用量在A组用量的基础上再增加10 mL。观察2组患者临床疗效、有无肝功能损害及生存、复发等情况。结果 B组总有效率明显高于A组（80.5%vs 46.5%,P〈0.05）。A组肿瘤较原病灶缩小1/3所占比例明显低于B组（28.6%vs 55.6%,P〈0.05）,A组肿瘤较原病灶缩小1/2所占比例明显低于B组（46.4%vs 69.4%,P〈0.05）。A组肝功能损害发生率明显高于B组（71.4%vs 41.7%,P〈0.05）。A组肿瘤周边复发率明显高于B组（53.6%vs 19.4%,P〈0.05）。A组术后3年生存率明显低于B组（0.0%vs 8.3%,P〈0.05）。结论超选择性插管并完全栓塞肝癌的血供及碘油用量的增加可以明显的提高疗效,而肝功能不会受到明显的损害。

Objective To evaluate the amount of iodized oil in interventional treatment of middle and late stage hepatic cancer.Methods Sixty-four patients with middle and late stage hepatic cancer were randomized to receive either chemoembolization of proper hepatic artery（group A,n=28） or superselective arterial chemoembolization（group B,n=36）.In group A,5F hepatic catheter was positioned in the proper hepatic artery with a large C-arm.After slow injection of 40 mg doxorubicin hydrochloride,50 mg cisplatin and 1 000 mg fluorouracil into proper hepatic artery through 5F hepatic catheter under fluoroscopic control,a mixture of 20 mg doxorubicin hydrochloride and 40% ultra-liquefied iodinate oil（10-20 mL） was given,followed by administration of gelatin sponge particles（10 mL）.In group B,transarterial chemoembolization of nutrient artery of the tumor was performed with 3F micro-catheter under C-arm fluoroscopic guidance.The anticancer drugs were the same as those in group A.But the amount of iodized oil was increased by 10 mL,compared with group A.Clinical efficacy,liver function damage,survival and recurrence were observed in both groups.Results The incidence of liver function damage and rate of tumor recurrence in group A were significantly higher than those in group B（71.4% and 53.6% vs 41.7% and 19.4%,respectively;P0.05）.The total effective rate,proprotion of 1/3 diminution in lesion area,proprotion of 1/2 diminution in lesion area,and 3-year survival rate in group A were significantly lower than those in group B（46.5%,28.6%,46.4% and 0.0% vs 80.5%,55.6%,69.4% and 8.3%,respectively;P0.05）.Conclusion The superselective chemoembolization of supplying artery and addition of iodized oil can significantly improve the curative outcome of middle and late stage hepatic cancer without obvious damage to liver function.