ContourSe微球联合碘油栓塞治疗大肝癌的初步临床研究  

Preliminary Clinical Study of Transcatheter Arterial Chemoembolization with ContourSe Microspheres and Lipiodol in Patients with Large Hepatocellular Carcinoma

作　　者：杨积慧[1] 颜志平[2] 王建华[2] 罗剑钧[2] 陈颐[2] 王平[2] 刘清欣[2] 吴安乐[2] 李说[2] 王永刚[2] 

机构地区：[1]上海交通大学附属第一人民医院放射科,上海200080 [2]复旦大学附属中山医院放射科,上海200032

出　　处：《中国临床医学》2008年第6期798-801,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨ContourSe微球联合碘油动脉栓塞治疗大肝癌的临床应用价值。方法:19例大肝癌,其中常规肝动脉化疗栓塞(TACE)治疗碘油廓清快的病例13例,初次治疗6例。常规动脉造影后行化疗栓塞。根据所用栓塞剂的不同分为2组,即(1)常规栓塞组(10例):在肿瘤供血动脉灌注化疗药物后,注入超液化碘油和表柔比星制成的乳剂,然后用明胶海绵条栓塞供血动脉;(2)微球碘油栓塞组(9例):微球作为辅助栓塞剂,超选择插管灌注化疗后,注入超液化碘油与ContourSe微球及表柔比星混合制成的混悬剂,供血动脉近端用明胶海绵栓塞。CT随访肿瘤大小变化,肿瘤坏死程度,碘油沉积情况;对比不同栓塞方法对肝功能的影响;栓塞前后AFP变化以及并发症发生情况。结果:常规栓塞组术后肿瘤缩小3例,无变化5例,增大2例;微球碘油栓塞组术后肿瘤缩小6例,无变化1例,增大2例,其中2例部分坏死,3例近完全坏死。微球碘油栓塞治疗与常规栓塞治疗对肝功能的影响无显著差别;微球碘油栓塞组术前及术后1个月肝功能无显著差别;微球碘油栓塞组术后AFP下降5例,发生肝脓肿1例,无其他严重并发症。结论:应用ContourSe微球作为辅助栓塞剂对大肝癌进行化疗栓塞安全可行,近期效果良好,尤其适用于大肝癌的首次介入治疗。Objective：To evaluate the clinic value of transeatheter arterial chemoembolization（TACE） with ContourSe microsphere and lipiodol in patients with large hepatocellular carcinoma（HCC）. Methods： Nineteen patients with large hepatocellular carcinoma including 13 patients with poor lipiodol deposition after routine TACE were treated with two different ehemoembolization protocols. Groupl （n = 10）,chemotherapy and emulsion of lipiodol and EADM followed by gelfoam pledgers, and group2 （n = 9）, chemotherapy and slurry of lipiodol, ContourSe（300-500μm） and EADM followed by gelfoam pledgets. Tumor necrosis, maximum tumor diameter and lipiodol deposition were followed up by CT. Postembolization syndrome, complication, AFP and liver function examination were assessed. Results： Maximum tumor diameter reductions were detected in 3 cases for group l and 6 cases for group 2. Complete necrosis was found in 3 cases for group 2, and partial necrosis in 2 cases for group 2. Complete compact lipiodol deposition was found in the tumors with lipiodol filling defect after routine TACE in 1 case for group2 . No significant difference in the change of liver function examination was detected between pre- and post embolization and between the two groups. AFP level decreased in 4 cases for groupl and 5 cases for group 2. laver abcess was found in one case for group 2. Conclusion：ContourSe microspheres as adjuvant embolic agents had good early response in TACE of large HCC. TACE with use of ContourSe for large HCC is feasible. The optimal indication for use of ContourSe is the first interventional therapy for large HCC.

关 键 词：肝癌 化疗栓塞 微球 碘油 

分 类 号：R735.7[医药卫生—肿瘤]