肝转移瘤血供对肝动脉灌注化疗栓塞近期疗效的影响

Blood supply of liver metastases on short-term effect of transcatheter arterial chemoembolization

目的通过数字减影血管造影(digital subtraction angiography,DSA)分析肝转移瘤(liver metastases,LM)血供对肝动脉灌注化疗栓塞(transcatheter arterial chemoembolization,TACE)近期疗效的影响。方法 LM患者326例,通过DSA分析LM血供来源,根据造影表现对LM血供进行分类,然后行TACE治疗,按照WHO实体瘤的疗效标准判断近期疗效。结果 LM血供来源于肝动脉,门静脉不参与供血。326例LM根据DSA造影表现分为多血供型83例,中等血供型69例,少血供型174例。TACE治疗LM有效(完全缓解+部分缓解)171例,总有效率为52.5%(171/326);少血供型LM总有效率明显低于多血供型和中等血供型LM(P<0.05)。326例LM 6个月生存率为89.9%(293/326),12个月生存率为59.8%(195/326);少血供型LM 6个月和12个月生存率均明显低于多血供型和中等血供型LM(P<0.05)。结论 LM由肝动脉供血,门静脉不参与供血;TACE治疗LM能明显延缓肿瘤进展,提高患者生存质量及延长生存期,随着LM血供的减少,TACE疗效逐渐降低。

Objective By analysis in the blood supply of liver metastases（LM）through digital subtraction angiography（DSA）,to explore the blood supply influence on the short-term effect of transcatheter arterial chemoembolization（TACE）.Methods Analysis was performed for the blood supply of LM by DSA in 326 patients,who were classified according to the blood supply of LM by imaging,and conducted TACE treatment,their short-term effects were judged by WHO standards.Results The hepatic artery supplied the LM,the portal vein was not involved.According the DSA features,326 LM cases were divided into the rich blood type（83patients）,the median blood type（69patients）,the poor blood type（174patients）.The TACE treatment proved effective（CR＋PR）to LM accounted for 171 patients,total effective rate 52.45%（171/326）.The total effective rate of poor blood type was less efficiently than that of rich blood type and median blood type（P〈0.05）.The survival rate for 326 patients for 6months and 12 months of lifetime was respectively 89.88%（293/326）and 59.82%（195/326）.The survival rate of 6months and 12 months of poor blood type was significantly lower than that of rich blood type and median blood type（P〈0.05）Conclusion TACE treatment can significantly delay tumor progression,improve the quality of life and prolong the survival period.With the loss of blood supply,the effects of TACE treatment gradually reduce.