瘤内注射酒精、门静脉灌注化疗联合治疗肝癌23例分析

Hepatic carcinoma treatment with percutaneous ethanol injection combined with portal infusion of drugs.

目的 探讨瘤体内注射无水酒精(PEIT)与门静脉灌注化疗联合应用治疗肝癌的价值。方法 23例均在超声引导下穿刺同时进行两种方法的介入治疗,瘤体行单点或多点注射,门静脉灌注化疗药物为5-Fu,顺铂,白介素Ⅱ。结果 23例中瘤体缩小2cm以上者8例,1—2cm者11例,无变化3例,增大1例,有门静脉癌栓4例,治疗后癌栓消失3例,缩小1例。瘤体声像图动态变化:维持高回声的13例,中回声7例,低回声1例,混合回声2例。CDFI:治疗前16例可测及血流频谱者治疗后均无血流显示。AFP测定,治疗前13例增高者,治疗后有12例降至正常,1例明显下降为50ng/ml。治疗后17例活检,l4例为坏死组织,3例仍可见癌细胞。结论 PEIT与门静脉灌注化疗的联合应用不仅对原瘤体有灭活作用,使肝癌的重要指标转阴率高,还可治疗门脉内癌栓,并有效预防肝内新生病灶。因此该方法对延长患者生存期,提高生存质量有重要临床价值。

Objective To evaluate the hepatic carcinoma treatment of percutaneously ethanol turner injection combined with portal infusion of drugs.Methods Twenty- three patients had been treated with ethanol single or mutiple shots and combined with 5Fu,cisplatinum or inter- leukin Ⅱ as infusion drugs. All these procedures were guided with ultasound. Results Eight casese regressed 2cm or more, less than 1 - 2cm in 11 cases. Tumor did not changed in 3 cases.And 1 case enlarged after injection. Acoustic imaging changed in tumors were 13 cases with persistent hyper- e-choic, medium echo in 7 cases, hypo - echoic in 1 case and 2 cases with mixed echoes. The arterial spectrum and venous stream were visible by CDFI before treatment,and were disappeared after injections. AFP were high in 13 cases and returned normal in 12 cases, 1 decreased to 50ug/ml.Seventeen cases had been histological examinations after treatment and 14 cases showed necortic tissues and 3cases still found casrcinoma cells. Conclusion PEITcombined portal infusion of drugs not only can devitalize the tumor itself, but also can treat the tumor thrombosis of portal vein and prevent the neoplasis of liver. It can be prolong patient's life and promote the living.