经肝动脉栓塞化疗结合局部消融治疗大肠癌肝转移  

Combined transhepatic arterial chemoembolization and local ablation for treating liver metastasis from colonic cancer

作　　者：罗鹏飞[1] 陆骊工[1] 陈晓明[1] 栾建华[1] 

机构地区：[1]广东省人民医院肿瘤中心介入治疗科,510080

出　　处：《介入放射学杂志》2003年第5期340-344,共5页Journal of Interventional Radiology

基　　金：2000广东重点攻关课题(2KB04601S)

摘　　要：目的 研究大肠癌肝转移的综合性介入治疗方法和疗效。方法 对35例大肠癌肝转移患者先行肝动脉造影,留置导管药盒系统,然后根据动脉造影结果分别行经动脉灌注化疗(TAI)10例,经动脉栓塞(TAE)25例,使用药物为草酸铂、CPT_(11)、丝裂霉素C和5-Fu+CF。2～3次治疗后,全部患者在CT导向下行消融术,其中9例在激光消融基础上加入无水乙醇。激光消融后1个月复查CT、CEA,判定疗效。结果 2～3次TAI和TAE后病灶缩小17例,不变13例,增大5例。14例CEA阳性者治疗后下降6例,不变5例,增高3例。加用消融术后,CT扫描显示,残癌中央斑点状气化29例,全部汽化6例。其中采用单纯激光消融的20例患者,病灶缩小8例,不变5例,增大7例。采用激光加无水乙醇治疗的9例中,缩小5例,不变2例,增大2例。TAE/TAI后CEA不变或升高的8例中,消融术后下降3例,不变4例,升高1例。结论 ①大肠癌肝转移灶主要由肝动脉供血,超选择插管可使病灶染色更为清晰。②留置PCS,行TAI/TAE,使用草酸铂、CPT_(11)及5-Fu序贯化疗方法对转移癌灶有较好的治疗作用。③TAI/TAE不能消除全部病灶,对残癌病灶使用激光或(和)无水乙醇等局部消融是有效的补充。Objective To investigate the therapeutic methods and curative effect of combined interven-tional therapy on hepatic metastasis from colorectal cancer. Methods Hepatic artery angiography and port-calheter-system( PCS) were undertaken in 35 cases of liver metastasis from colorectal cancers. Therapeutic measare were divided into transcatheter arterial infusion(TAl) in 10 cases and transcatheter arterial emboliza-tion(TAE) in 25 cases according to their angiographic features. Drugs included oxalic acid platinum, CPT11 , MMC and 5-Fu + CF. Laser ablation under the CT guidance was taken after 2-3 courses of treatment, including 9 cases of ethanol ablation besides laser ablation. The curative effects were determined after laser ablation by checking with CT and CEA one month later. Results The lesions shrank in 17 cases, while 13 remained the same and enlarged in other 5 after 2-3 courses of TAE or TAI. CEA reduced in 6 cases, with no change in other 5 and increas in another 3 among the 14 positive CEA cases. CT scan showed spotty gasification in 29 cases and whole gasification in 6 after additional ablation treatment. Among them, the foci dwindled in 8 cases treated by solely laser ablation, with no change in 5 and increase in 7. The foci dwindled in 5 cases, 2 remainal the same and increase in 2 of 9 cases treated by the combination of laser ablation and percutaneous ethanol injection (PEI). Among 8 unchanged or increased CEA cases after TAE or TAI, showed decrease in 3 cases, other 4 remained the same and another increased after ablation. Conclusions 1. The blood supply of hepatic metastastic foci from coloreclal cancer is mainly fed by hepatic artery and subselective transcatheter angiography showed tumor stain clearly. 2. By means of PCS and TAI or TAE, using oxalic acid platinum, CPT11 and 5-Fu regular chemical therapy provided a better curative effect for metastasis. But 3. TAI or TAE can not eliminate all foci laser combining with ethanol ablation would be the effective complement.

关 键 词：经肝动脉栓塞化疗 局部消融治疗 大肠癌 肝转移 综合性介入治疗 肝动脉造影 

分 类 号：R735[医药卫生—肿瘤]