三丙烯微球夹心疗法在肝动脉-门静脉分流型肝细胞癌介入治疗中的应用

Clinical application of trisacryl gelatin embosphere in interventional therapy for hepatocellular carcinoma with arterioportal shunt

目的探讨三丙烯微球夹心肝动脉化疗栓塞术在肝动脉-门静脉分流(APS)型肝细胞癌(HCC)介入治疗中的应用。方法选择11例存在中、低流量APS的HCC患者,先采用三丙烯微球栓行APS封堵后,用化疗药物及碘油混合乳剂行化疗及栓塞治疗,再用三丙烯微球栓进行肿瘤供血血管栓塞的肝动脉化疗栓塞术(TACE)治疗。结果栓塞后1个月及其后复查显示APS明显改善,封堵有效率100%。CT影像显示肿瘤明显好转(原发肿块缩小>75%)2例,好转(原发肿块缩小75%～30%)5例;明显好转+好转占总病例数63.6%。生存率>1年者10例(90.9%)。结论三丙烯微球夹心TACE介入治疗APS型肝细胞癌,可以有效封堵APS,顺利实施TACE。三丙烯微栓球栓塞性能优越,临床疗效确切,不良反应少。

Objective To evaluate the effectiveness of trisacryl gelatin embosphere in interventional therapy for the hepatoce-llular carcinoma （HCC） with arterioportal shunt （APS）.Methods Eleven cases of HCC with medium and low APS were selected and administered by the ＂sandwich＂ technique in which transcatheter arterial chemoembolization （TACE） was used with chemotherapeutic drug and lipiodol farrago, and then trisacryl gelatin embosphere for embolizing the supplying vessels of tumor after using trisacryl gelatin embosphere to embolize the arterioportal fistula.Results The CT images showed that the arterioportal fistula of all cases improved significantly a month later and there after; the primary mass reduced over 75% in 2 cases and 30% to 75% in 5 cases. The overall effective rate reached 63.3% with 1-year survival rate of 90.9%.Conclusion The ＂sandwich＂ technique consisting of trisacryl gelatin embosphere can effectively embolize the arterioportal fistula so that the TACE may be smoothly performed in interventional therapy for the HCC.