超常规剂量碘油超选择TAE与常规TAE后Ⅱ期肝癌切除—27例手术病理及随访研究

Resection of hepatocellular carcinoma following superselective TAE with ultra-routine dose iodized oil versus routine TAE:Follow-up and pathological correlation

目的 评价术前应用超常规剂量碘油超选择TAE与常规TAE治疗原发性肝癌的价值。方法 1987年 8月～ 1999年 12月 12年间 2 7例原发性肝癌分为两组 :治疗组 17例 ,应用常规导管或球囊导管超选择至肿瘤供血动脉 ,阻断其血流 ,使注射碘油时不产生逆流 ,将全部动脉肿瘤血管、病变周围正常的小动脉及肝实质和门静脉分支栓塞 ,栓后2 5天～ 12 1天手术切除 ;对照组 10例 ,应用一般导管 ,常规剂量的碘油超选或不超选栓塞肿瘤供血动脉 ,栓后 2 0天～14 0天手术切除。对两组病人切除的标本均进行了详细的病理学研究 ,同时对全部病人随访 3～ 8年。结果 治疗组 17例中 11例肿瘤 10 0 %坏死 ,其余 6例坏死率为 85 %～ 95 % ,3、5年生存率分别为 88.2 % (15 /17)、45 .5 % (5 /11) ,3例现生存 6～ 8年 ;对照组 10例中 2例肿瘤完全坏死 ,另 8例坏死率为 75 %～ 95 % ,3、5年生存率分别为 60 .0 % (6/10 )、14 .3 % (1/7)。结论 术前应用超常规剂量碘油超选择TAE治疗原发性肝癌效果明显好于常规TAE。

Objective To evaluate the value of superselective transcatheter arterial embolization(TAE) with ultra routine dose iodized oil versus routine TAE before liver resection in primary hepatic carcinoma.Methods 27 cases of hepatocellular (HCC) resected after transcatheter arterial embolization from 1987 to 1999 were retrospectively analyzed.According to different therapeutic methods,the patients were divided into two groups:therapeutic group(17case),who received superselective TAE with ultra routine dose iodized oil;control group(10cases),who were treated with routine TAE.The curative effects of the two groups were evaluated by their survival rates and degrees of tumor necrosis.The surgical specimens were studied histopathologically.Results The embolization of the supplying artery of the tumor,small normal artery and hepatic parenchyma around tumor was carried in all the 17 patients of the therapeutic group,of whom 15 received the embolization of hepatic portal vein branches.The interval between the first embolization and operation was 25～121 days.The 3 ,5 year survival rate was 88.2%,45.5% respectively.Pathological study revealed no viable tumor cells in ll casese and extensive necrosis (85%～95%)in the remaining 6.As for patients in the control group,only the embolization of the supplying artery of the tumor was carried out and The 3 ,5 ,year survival rates were 60.0%、14.3%.Pathological study revealed no viable tumor cells in 2 cases and extensive necrosis (75%～95%)in the remaining 8.Various degrees of necrosis were found in the satellite lesions,tumor thrombus in the portal vein and the infiltrating tumor cells in the capsule in all the 27 patients.Conclusions Superselective TAE with ultra routine dose iodized oil before hepatectomy shows more significant clinical effect than routine TAE before hepatectomy for the treatment of primary hepatic carcinoma. [