^(32)磷玻璃微球经肝动脉综合性栓塞治疗晚期肝癌的副反应及其防治

THE SIDE EFFECT AND ITS PREVENTION OF RADIO-CHEMO-EMBOLIZATION USING PHOSPHORUS-32 LABELLED GLASS MICROSPHERES FOR 44 PATIENTS WITH NONRESECTABLE LIVER MALIGNANCIES

目的 :观察磷微球治疗晚期肝癌的副反应并探讨其防治方法。方法 :1994年 3月至 1998年 2月 ,采用32 磷 玻璃微球 ( phosphorus 32 glassmicrospheres ,32 P GMS) 2 .6～ 17.9mCi,术中栓塞法附加肝动脉结扎及置管化疗 2 3例 (OAE +HAL) ,经Seldinger导管栓塞法 2 1例 (TAE) ,以纯甘油或碘化油作媒介加化疗药制成放化疗综合性栓塞液。结果 :全组OAE +HAL组副反应高于TAE组 ;均无骨髓抑制和肾毒性 ;肝功指标多呈一过性改变 ,4例肝功恶化 ;肺、胃肠、脾、脑、胆、胰异位栓塞各为 2、3、1、1、4、2例。 4 4例肿瘤缩小率为 4 6.7+2 4 .5% ( 0～ 91.8% ) ,9/ 2 3例癌栓缩小 ,2 5/2 7例AFP下降 ,肿瘤稳定期 5.3± 3.9月 ,平均生存 12 .5± 9.2月。结论 :61μ的32 P GMS可成为治疗肝癌安全有效的临床医用生物材料。良好的病例选择。

Objective: To survey the complication and efficacy of selective internal radioembolization using phosphorus32 glass microspheres combined with chemoembolization for advanced liver cancer. Method: From 1994.3 to 1998.2, 44 patients with unresectable hepatic carcinoma (39 primary and 5 metastatic) recieved combined radiochemoembolization with mixed emulsion of 32 PGMS(8.8±4.2 or 2.6～17.9mCi), chemoagent (Adr 20mg, 5Fu 1g and Mmc 10mg) and glycerine or lipiodol (average 14 or 12ml), via intraoperative hepatic artery instillation (23 cases, following hepatic artery ligation, OAE+HAL) or transcatheter hepatic artery embolization (21 cases, TAE). Result: There was no significant bone marrow or renal toxicity, longitudinal gastrointestinal tract reaction and transient change of liver function test occurred in almost all patients while liver dysfunction happened in four cases, pulmonary, gastrointestinal, splenic, cerebral, pancreatic and gallbladder embolization were seen in 2,3,1,1,4 and 2 cases respectively, moreover, the toxicity was more taken place in OAE group. The tumor shrinking rate were 46.7±24.5%(0～91.8%) and the average survival time for those patients were 12.5±9.2 month. Conclusion: The combined radiochemoembolization appears to be more effective and safe by and large. The reasonable internal radiation doses, preoperative selection of patients and intraoperative skill was very important to either reduce shortterm complication or longterm survival.