小肠平滑肌类肉瘤肝转移的影像学评价和介入治疗

Imaging evaluation and interventional therapy of hepatic metastases from small intestinal leiomyosarcoma

目的 评价小肠平滑肌类肉瘤肝脏转移的影像学表现和介入治疗的短期疗效。方法 回顾性分析７例小肠平滑肌类肉瘤肝脏转移病例，共计４６个病灶。病灶直径２～１８ｃｍ不等。所有患者均行肝脏ＣＴ三期扫描和肝动脉造影。介入治疗７例均采用肝动脉化疗栓塞术（ＴＡＣＥ），ｌ例行左锁骨下动脉植入化疗药盒导管系统术（肝动脉ＰＣＳ术）。３例肿瘤中心液化坏死明显的患者还行经皮坏死物引流和肿瘤内无水酒精注射。结果４６个肝脏转移病灶均表现为实质性或囊实性占位，肿瘤较大时囊变成份增加。ＣＴ动脉期增强扫描肿瘤明显强化，肝动脉造影肿瘤血管、染色丰富。随访３～１０月（平均６．７月），４例经肝ＴＡＣＥ术后肿瘤缩小，ｌ例行肝动脉ＰＣＳ术患者肿瘤大小无变化，２例肿瘤增大。３例经皮肿瘤坏死物引流者肿瘤缩小明显。结论 小肠平滑肌类肉瘤肝脏转移以肝动脉供血为主，为富血供肿瘤。肝ＴＡＣＥ术、肝动脉ＰＣＳ术和经皮坏死物引流术是其治疗的有效方法。

Objective To evaluate the imaging appearances and the short-term curative effect of hepatic metastases from small intestine leiomyosarcoma treated by interventional methods. Metbods Seven cases with 46 lesions of hepatic metastases from small intestinal leiomyosarcoma were analyzed retrospectively. The diameters of the metastases were from 2 cm to 18 cm. CT triphasic scan and hepatoarterial angiography were performed in all cases. The interventional therapy methods included transcatheter arterial chemoembolization（TACE)（all 7 cases), percutaneous left subclavian artery port- catheter system implantation（PCS)（1 case). Three cases were also treated with percutaneous tumor necrosis drainage (PTND) because of obvious liquefaction necrosis within the tumor. Results The lesions were substantial occupation and some were mixed density with cystic component. The cystic component increased in the larger tumor. The hepatic me- tastases were enhanced remarkably during the hepatic arterial-dominant phase scan and had abundant tumor vascular and tumor stain on hepatoarterial angiography. The size of tumor in 4 cases was reduced after TACE. The tumor in the patient who was treated with PCS had no changed. The size of the tumor in 3 cases was slightly enlarged. The tumors in the 3 pa- tients treated with PTND were reduced remarkably. Conclusions The predominant blood-supply of the hepatic metastases from small intestinal leiomyosarcoma is the hepatic artery abundant in blood vessels. TACE, PCS and PTND are effective methods to treat hepatic metastases from small intestinal leiomyosarcoma.