大肝癌TACE后手术切除标本的病理研究

PATHOLOGICAL STUDY OF RESECTED SPECIMENS OF RESECTABLE LARGE HEPATOCELLULAR CARCINOMA AFTER TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION

目的 探讨可切除大肝癌 TACE后手术切除标本的病理改变及其意义。方法 2 0 0 2年 1月～ 2 0 0 3年 1月收治的 83例可切除大肝癌患者随机分成术前 TACE组 (n=36 )与 期手术组 (n=4 7) ,术前 TACE组 31例 期切除 ( 期手术组 ) ,5例失去手术切除机会 ,78例术后病理均证实为肝细胞癌。对比两组标本间主瘤、包膜、子灶、癌栓、肝硬化等病理情况。 结果 TACE组除较 期手术组肿瘤坏死广泛、包膜更完整外 ,两组间子灶及门脉癌栓发生率、肝外浸润转移无显著差异 ;TACE组 TACE后肿瘤体积缩小并不显著 ,子灶、门脉癌栓完全坏死者少 ,肝硬化加重。结论 可切除大肝癌术前 TACE不能使肿瘤完全坏死 ,部分患者耽误手术时机 。

Objective To investigate pathological changes and significance in resected specimens of resectable large hepatocellular carcinoma(HCC) after transcatheter arterial chemoembolization(TACE).Methods From January 2002 to January 2003,83 patients with resectable large primary liver cancers were prospectively randomized into two groups:preoperative TACE group(n=36)and one stage operation group(n=47),hepatectomy was performed in 31 out of 36 patients(two stage operation group)and operative chances was lost in 5 out of 36 patients after TACE in preoperative TACE group.78 patients were proven HCC histologically after hepatectomy.The pathological changes of resected specimens were compared between two group including main tumor,capsular containment,daughter nodules,tumor thrombus and liver cirrhosis.Results There were no significant difference in the incidence of daughter nodules,portal vein tumor thrombus(PVTT) and extrahepatic metastasis in the two groups,but the main tumor necrosis areas was more extensive and the rates of encapsulation was higher in TACE group than those in no TACE group.However there were no significant shrinkage in the average tumor size after TACE in TACE group,the daughter nodules and PVTT necrosis were rare,liver cirrhosis was more serious in TACE group.Conclusion Preoperative TACE for resectable large HCC should be used on bases of strict selection because it does not provide complete necrosis in tumor and results in delayed surgery in some cases.