肝癌的介入性热化疗:最佳灌注温度的探讨  

Evaluation of the optimal temperature for interventional thermochemotherapy treatment of hepatic carcinoma

作　　者：张家兴[1] 樊树峰[2] 郑家平[1] 叶强[1] 汝复明[1] 奚顺法[1] 童乾纲[1] 顾伟中[1] 

机构地区：[1]上海同济大学附属第十人民医院介入科,200072 [2]浙江省台州医院放射科

出　　处：《介入放射学杂志》2004年第5期450-452,共3页Journal of Interventional Radiology

摘　　要：目的　探讨肝癌经肝动脉行介入性热化疗的最佳灌注温度。方法　实验猪 8头 ,按不同灌注温度随机分为 4组 ,每组 2头 ,分别灌注 4 5、5 0、5 5和 6 0°C(导管流出温度 )的生理盐水。术后 14d将实验猪处死 ,取出肝脏进行病理检查。同时观察热灌注前后肝、肾功能、凝血功能和一般情况的变化。评价热灌注的适宜温度。临床上选取肝癌 35例 ,采用温热灌注化疗栓塞治疗。将 80cm 5F导管超选至肿瘤的供血动脉内 ,先灌注 6 0～ 6 5°C ,导管流出温度 (4 7.5 5± 0 .4 4 )°C ,化疗药液。再用 6 0～ 6 5°C化疗药碘油乳剂栓塞。定期随访 ,评价其疗效和不良反应。结果　实验猪肝动脉热灌注显示 ,出导管温度 >5 0°C热灌注导致肝功能明显受损 ,并伴有不同程度的发热和食欲下降、精神萎靡等不良反应 ;其中 6 0°C组 ,热灌注区见大片状热凝固坏死 ,5 5°C组热灌注区可见点灶、斑片状的热凝固坏死。≤ 5 0°C对肝功能和机体影响不明显 ,热灌注区未见明显异常的病理改变。临床上以 (4 7.5 5± 0 .4 4 )°C进行介入性热化疗治疗肝癌 ,近期随访肿瘤的生长率为 - (0 .35± 0 .32 ) ,有效率 (PR +CR)为 79.2 % ;0 .5、1和 1.5年生存率分别为 10 0 % (35例 )、80 % (2 8例 )和 6 0 % (2 1例 )。不良反应与文献报道的常规介入?Objective To explore a safe and effective hyperthermia interventional therapy temperature for hepatic carcinoma. Methods Eight swines were divided into four groups according to trans-arterial hyperthermic perfusion temperature, 45 °C , 50 °C ,55 °C , and 60 °C (catheter flowing temperature) groups. The hepatic and renal functions and blood coagulation function were examined before and after the procedur and then all swines were sacrificed and the livers were pathologically analysed,simultoneously with the evaluation of the safe hyperthermic temperature 35 hepatic carcinomas were carried out under this interventional hyperthermochemotherapy via the arterial catheter (80 cm, 5F) placed into the tumoral artery with the perfusion agents warmed to 60～65 °C (catheter flowing temperature was 47.55±0.44 °C ). Results The hyperthermic coagulation necrosis, hepatic dysfunction level and fever were found after 55 °C and 60 °C hyperthermic perfusion while those of 45 °C and 50 °C groups basically remained normal. The tumor growth rate and total efficacy rate were -(0.35±0.32) and 79.2%, respectively, and 0.5, 1, 1.5 year survival rates were 100%, 80%, 60% respectively after follow-up. The adverse effects of the interventional hyperthermochemotherapy was similar to the routine TACE. Conclusions 45 °C and 50 °C (catheter flowing temperature) hyperthermochemotherapy for hepatic carcinoma is safe and effective.

关 键 词：肝癌 介入性热化疗 灌注温度 治疗 

分 类 号：R735.7[医药卫生—肿瘤]