大剂量碘化油在原发性巨块型肝癌中的临床应用

The Utility of Large Dose Lipiodol Treatment in Huge Primary Hepatic Carcinomal

目的：回顾性分析原发性肝癌经大剂量碘化油化疗栓塞的临床疗效及安全性。方法：164例原发性巨块型肝癌分成两组,分别经肝动脉注射常规剂量碘化油（20 m L）及大剂量碘化油（25-45 m L）化疗栓塞,对比两组介入前后的肝功能、肿瘤最大直径,并记录并发症、碘油沉积情况、生存时间。结果：所有患者均未发生严重并发症,大剂量组的碘化油用量平均为28.3 m L,常规组介入术前直径（12.47±3.04）cm,介入术后4周（12.15±3.11）cm,大剂量组介入术前（13.15±5.32）cm,介入后4周（11.98±3.08）cm,两组术前与介入术后4周比较差异均无统计学意义（P〉0.05）;术后1周随访肝功能均有不同程度的损害,2周后均可恢复。治疗后常规剂量组中位生存时间6个月,大剂量组为8个月,大剂量组6、12、18、24个月累积生存率分别为55.8%、32.2%、24.0%、13.7%,长于常规剂量组,差异具有统计学意义（P〈0.05）。结论：原发性巨块型肝癌大剂量的碘油栓塞是安全的,大剂量碘油介入治疗巨块型肝癌的疗效优于常规剂量。

Objective：To evaluate the effect and safety of large dosage iodized oil（1ipiodol） treatment in huge primary hepatic carcinoma（PHC） via injecting from hepatic artery transarterial chemoembolization（TACE）. Method：One hundred sixty-six cases of huge PHC received 20 mL lipiodol or 25-45 mL lipiodol injection in each TACE.Tumor maximal diameter and liver function were recorded both before and after TACE.Angiography,lipiodol dosage and deposition in tumor and complications were also recorded.Result：All patients were followed-up 1 and 4 weeks after TACE respectively.The average dosage of large-lipiodol was 28.3 mL.Tumor maximal diameter was decreased[（13.15±5.32）cm vs （11.98±3.08）cm ].There was no statistical significance before and after operation in the two groups（P〉0.05）.Some impairment of liver function was found in those patients after TACE 1 week.No major impairment of liver function was found in those patients after TACE 2 week.Median survival time of the conventional dose group were 6 months,while large dose group were 8 months.The survival rates of 6,12,18,24 months after treatment were 55.8%,32.2%,24.0%,13.7%.No severe complication happened in this series.The survival time of large dose group was longer than that of the conventional dose group, with statistical significance（P〈0.05）.Conclusion：It is effective and safe for patients with huge primary liver cancer patients to receive high dose lipiodol TACE.The effect of large dose lipiodol treatment on mass hepatocellular carcinoma is superior to the common.