同轴微导管肝动脉化疗栓塞联合射频消融治疗原发性肝癌  

Hepatic arterial chemoembolization via a coaxial microcatheter combined with radiofrequency ablation for the treatment of primary hepatocellular carcinoma

作　　者：李家开[1] 张晶[1] 于淼[1] 张金山[1] 杨立[1] 肖越勇[1] 

机构地区：[1]解放军总医院放射科,北京100853

出　　处：《介入放射学杂志》2009年第5期331-334,共4页Journal of Interventional Radiology

摘　　要：目的探讨经肝动脉微导管化疗栓塞(TACE)联合射频消融(RFA)术治疗原发性肝癌(HCC)的疗效。方法回顾分析1 000例HCC的DSA表现与术前多层螺旋CT(MSCT)检查结果。其中179例病灶局限于1个肝段,采用微导管超选择插管栓塞。术后4周复查动态增强CT和(或)MR,对40例病灶碘油聚集不良者,进行RFA,术后1个月复查。结果DSA发现直径3 cm以上肿块670例,3 cm以下病灶202例,子灶400例,动静脉瘘、动门脉瘘482例,异常血供430例,门脉癌栓362例。局限于1个肝段的病灶,微导管栓塞后4周,肿瘤局部控制率为77.6%;控制不良者行RFA后1个月,肿瘤局部控制率为97.5%。结论DSA对于发现3 cm以下小病灶(含子灶)、肿瘤血供、动静脉瘘、动门脉瘘具有绝对的优势,对HCC的术前评价具有不可替代性的作用。RFA是HCC的有效的治疗方法,是TACE疗效不佳者的理想选择。Objective To discuss the therapeutic efficacy of transcatheter arterial chemoembolization （TACE） via a coaxial microcatheter combined with radiofrequency ablation （RFA） for primary hepatoeellular carcinoma （HCC）. Methods The preoperative DSA and multi-slice CT findings in 1 000 patients with HCC,encountered from May1998 to May 2007, were retrospectively analyzed. In 179 cases, the lesion was limited in one hepatic segment, and super-selective catheterization TACE with a coaxial microcatheter was performed in these patients. Four weeks after TACE, dynamic enhanced CT and/or MR scanning was made to observe the results. In 40 cases, there was poor lipiodol deposit in the lesion, and CT-guided RFA was employed for these patients. Follow-up check was done one month after the treatment. Results DSA examination totally revealed 670 lesions with diameter larger than 3 cm, 202 lesions with diameter smaller than 3 cm, 400 satellite nodules, 482 arteriovenous fistulae or arterio-porta] shunts, 430 abnormal blood-supplying vessels and 362 cancerous thrombosis in portal vein. Four weeks after microcatheter embolization, the local control rate of the tumor was 77.6%. RFA was carried out for patients with poorly-controlled tumors, and one month after RFA the local control rate of the tumor reached 97.5%. Conclusions DSA is the most powerful examination means in detecting lesions less than 3 era, satellite nodules, tumor＇s blood-supply, arteriovenous fistulae and arterio-portal shunts. Therefore, DSA plays an important role in making the preoperative evaluation of HCC, undoubtedly, this role can not be substituted by any other equipment. RFA is an effective treatment for HCC as well as an ideal alternative for patients who show poor response to TACE.

关 键 词：肝癌 数字减影血管造影 微导管 肝动脉化疗栓塞术 射频消融术 

分 类 号：R735.7[医药卫生—肿瘤]