探讨化学消融在肝周转移瘤治疗中的价值

Clinical evaluation of chemical ablation in treating metastatic tumors located at hepatic periphery

目的探讨化学消融术在肝周转移瘤治疗中的临床应用价值。方法对77例肝周转移瘤施行化学消融治疗,比较肿块灭活程度、体积及消融前后相关癌胚抗原变化。结果化学消融后1个月行CT复查,38例肝包膜下转移瘤患者,瘤体缩小27例;病灶消失2例,增大9例。肝门区病灶17例,治疗后11例缩小,3例大小无变化,3例进展。胃癌肝门区淋巴结转移瘤22例,其中15例单个病灶缩小,3例无变化,4例进展。总有效率为70%。治疗后30例患者腹部疼痛症状明显改善。10例胆管梗阻患者胆管受压缓解,黄疸指数下降。化学消融术后肿瘤相关指标明显下降(P<0.01)。结论化学消融技术在肝周转移瘤的治疗中创伤小、肿瘤毁损彻底、费用低、适用于晚期转移瘤患者的局部治疗。

Objective To investigate the clinical application of chemical ablation in the treatment of metastatic tumors located at hepatic periphery. Methods A total of 77 patients with metastatic tumors located at hepatic periphery received chemical ablation therapy. The inactivated degree, the volume and the related carcinoembryonic antigens of the tumors were estimated before and after the treatment. The results were analyzed and the preoperative data were compared with the postoperative ones. Results Follow-up CT scanning was performed one month after the treatment. Of the 38 patients with hepatic subcapsular metastases, regression of the tumor was seen in 27, disappearance of the tumor in 2 and enlargement of the tumor in 9. For the tumors located at the hepatic portal, the lesions became smaller in 11 cases, unchanged in 3 cases and deterioration in 3 cases. Twenty-two patients had hepatic portal lymphatic metastases from gastric cancer. Of these 22 patients, the regression of the tumor was seen in 15, unchanged tumor in 3 and deterioration of the tumor in 9. The overall effective rate was 70%. Clinically, abdominal pain was markedly relieved in 30 patients. Biliary tract obstruction was obviously alleviated in 10 patients with a reduction of icteric index. After the chemical ablation the related carcinoembryonic antigens levels decreased significantly （P 〈 0.01）. Conclusion For the treatment of metastatic tumors located at hepatic periphery, the chemical ablation technique is minimally-invasive, clinically-effective and economical. This therapy is especially suitable for the patients with advanced hepatic metastatic tumors.