原发性肝癌肝外供血动脉TACE治疗的可行性评估

Feasibility of transcatheter arterial chemoembolization by extrahepatic arteryin treatment of primary hepatocellular carcinoma

关键词:  原发性肝肿瘤  动脉  介入治疗

Key words:  hepatocellular carcinoma  artery  interventional therapy

摘要:

目的 探讨原发性肝癌(hepatocellular carcinoma, HCC)经肝外供血动脉行动脉化疗栓塞(transcatheter arterial chemoembolization, TACE)治疗的可行性。方法 回顾分析2002年1月至2014年8月间收治的42例存在肝外供血动脉并行TACE治疗的HCC患者影像学及临床资料。结果 本组共42例HCC患者存在肝外供血动脉,发生率为5.2%(42/803),其中,右膈下动脉31例(73.8%)、胃左动脉4例(9.5%)、胃十二指肠动脉、胃网膜动脉各2例(4.8%)、右肾上腺动脉、右肾包膜动脉、胸廓内动脉各1例(2.4%)。所有患者均经肝外动脉成功实施TACE治疗。TACE术后4~6周,术前23例甲胎蛋白(alpha-fetoprotein, AFP)＞400g/L的患者,AFP表达量由术前的(1140.1±347.1)g/L降至(147.3±79.5)g/L(P<0.01)；33例患者肿瘤病灶碘油沉积率＞80%,7例碘油沉积率＞50%,2例碘油沉积率＜50%。结论 经肝外供血动脉行TACE治疗是可行的。

Abstract:

Objective To investigate the feasibility of transcatheter arterial chemoembolization (TACE) by extrahepatic artery in treatment of hepatocellular carcinoma (HCC). Methods Clinical data of 42 HCC patients with extrahepatic artery undergoing TACE between January 2000 and August 2014, were retrospectively analyzed. Results Among 42 cases with extrahepatic arteries, right inferior phrenic artery was used in 31 cases, left gastric artery in 4 cases, gastroduodenal artery and gastroepiploic artery in 2 cases respectively, right adrenal artery, right renal capsular artery, internal thoracic artery in 1 case respectively. TACEs were performed successfully in all cases. The serum alpha-fetoprotein (AFP) levels were reduced from (1140.1 ± 347.1) g/L before treatment to(147.3±79.5)g/L one month after TACE in 23 cases with pre-treatment AFP >400g/L (P<0.01). Lipiodol deposition rate at 4-6 weeks post-TACE was >80%, 50%-80% and<50% in 33,7 and 2 cases, respectively. Conclusion Results indicate that TACE by extrahepatic artery is feasible and it can improve the efficacy of treatment for HCC patients.