CT透视引导下经皮乙酸消融治疗第二肝门部恶性肿瘤

CT-guided percutaneous acetic acid injection for the malignant tumor at second porta hepatis

目的 评价CT透视引导经皮穿刺乙酸注射治疗 (PAI)第二肝门区恶性肿瘤的安全性和效果。方法 搜集西南医院 2 0 0 0年 5月至 2 0 0 3年 10月在实时CT透视导向下经皮穿刺乙酸注射治疗第二肝门区恶性肿瘤 17例 ,肝细胞癌 10例、转移性腺癌 7例 ,共 2 0个病灶。病灶直径 2～ 5cm。根据病灶大小每次注入 5 0 %～ 6 0 %乙酸 2～ 6ml不等 ,乙酸内加入 1ml对比剂混匀 ,以了解乙酸在肿块内的弥散程度和范围。注射后 1周影像检查 ,根据情况重复注射 1～ 2次。结果 在实时CT透视下均能准确穿刺到靶点 ,除 12例轻中度疼痛外无其它并发症。全部病例均经B超或CT随访 ,3个月时 ,其中瘤灶缩小 14个 (70 % ) ,肿瘤大小无变化 4个 (2 0 % ) ,肿瘤增大 2个 (10 % )。 17例随访 3月 ,全部生存 ;12例随访 1年 ,9例生存 ,5例失访 ;6例随访 2年 ,3例生存 ,3例失访。

Objective To evaluate safety and efficacy of CT-guided percutaneous acetic acid injection (PAI) for the malignant tumor at second porta hepatis. Methods PAI had been performed under anesthesia on twenty focal lesions in 17 patients with malignant tumor (Hepatocellular carcinoma in 10, metastatic adenocarcinoma in 7) at second porta hepatis from May 2000 to October 2003 in Southwest Hospital. All procedures were performed under CT fluoroscopic guidance. The mean diameter of the lesions is (3.7± 0.9)cm (ranges 2～5 cm). Acording to the size of lesions, 2～6 ml of 50%～60% acetic acid was injected into the lesions. PAI was repeated once or twice in the same lesions after a week according to the imaging. Results The needle could reach targets under CT guidance in all patients. No complication was observed except for moderate pain in 12. The tumors shrunk in 14 lesions, remained unchanged in 4 lesions, and increased in 2 lesions. The efficiency was 90%. All 17 patients were survival during the 3-month followup. 9 of 12 patients followed for 1 year survival. 3 of 6 patients followed for 2 years several. Conclusions CT guided percutaneous acetic acid injection (PAI) for malignant tumor at second porta hepatis safe and effective.