超声介入无水乙醇量化治疗合并肝硬化的复发性肝癌的临床研究  

Percutaneous quantified ethanol injection in the treatment for recurrent hepatocellular carcinoma with intercurrent hepatocirrhosis

作　　者：林礼务[1] 林学英[1] 薛恩生[1] 何以敉[1] 高上达[1] 林晓东[1] 吴丽足[1] 

机构地区：[1]福建医科大学附属协和医院超声科

出　　处：《中国医学影像技术》2006年第1期117-120,共4页Chinese Journal of Medical Imaging Technology

基　　金：福建省科委研究基金资助(2000Z138)。

摘　　要：目的 评价超声介入注射无水乙醇量化（PQEI）治疗合并肝硬化复发性肝癌的临床应用价值及其相关技术。方法 临床病理证实的合并肝硬化复发性肝癌298例。行超声介入无水乙醇量化注射治疗，注射量按回归方程Y=2．885X（当肿瘤直径≤5cm时），Y=1．805X（当肿瘤直径〉5cm时）计算（X为肿瘤最大直径，单位为cm；Y为注射乙醇量，单位为m1），每周注射2～3次，≤5cm的肿瘤结节4～10次为一疗程，〉5cm肿瘤结节以10～20次为一疗程。病例随访12～60个月。观察临床症状与体征，并结合相关检查结果。统计1、2、3、4、5年生存率。结果 超声引导无水乙醇量化注射治疗后肿瘤平均直径从3．4cm降为2．8cm。治疗后1、2，3、4、5年生存率分别为89．7％、78．8％、66．3％、56．5％和46．7％，中位数生存期为44．2个月。298例HCC先后进行2871次PQEI，除短期内出现疼痛、低烧、轻度黄疸等，均无大出血和严重心、肾功能损害等并发症发生，其中4例因合并严重的肝硬化肝功能衰竭而死。结论 超声介入无水乙醇量化治疗合并肝硬化复发性肝癌有较高的临床应用价值，值得深入研究。Objective To evaluate the clinical application value of percutaneous quantified ethanol injection （PQEI） in the treatment for recurrent hepatocellular carcinoma （HCC） with intercurrent hepatocirrhosis. Methods The tumors in 298 cases of elinicopathologleally proven HCC were injected with quantified ethanol guided by ultrasound every 2-3 days. The quantity of ethanol was calculated according to the regressive equations which were Y= 2. 885X when the mass wa s≤5 cm in diameter and Y=1. 805X when the mass was 〉5 cm in diameter （X was the maximal diameter of the mass with the unit cm, Y was the ethanol quantity with the unit rnl）. The ethanol was injected for 4-10 times per period for tumors 45 cm in di ameter and 10-20 times per period for tumors 〉5 cm in diameter. The follow up period lasted 12-60 months. The therapeutic efficacy was assessed by clinical symptom, the result of US, CT, MRI, color three-dimensional ultrasound and biopsy. The survival rates of 1,2,3,4,5 years were calculated. Results All the 387 nodules in 298 cases of HCC shrank from 3.4 cm to 2.8 cm in average diameter after 2-8 weeks since the last PEI. The survival rates of 1,2,3,4,5 years were 89.7%, 78.8%, 66.3M, 56.5% and 46.7%, respectively. The median survival time was 44.2 months. The 298 cases underwent 2871 PQEI in total. There were no complications such as hemorrhage and severe heart and kidney damage except different degree of pain, low-fever, iaundice in short period of time. Four cases died companion of serious hepatocirrhosis which resulted in liver function failure. Conclusion PQEI is of high clinical application value for the treatment of recurrent hepatocellular carcinoma and deserves further research.

关 键 词：癌 肝细胞 肝硬化 超声介入 无水乙醇 量化治疗 

分 类 号：R735.705[医药卫生—肿瘤] R815[医药卫生—临床医学]