经皮穿刺瘤内注入碘油化疗药乳剂治疗原发性肝癌
경피천자류내주입전유화료약유제치료원발성간암
Percutaneous intratumoral injection of lipiodol and chemotherapeutic agents emulsion for primary liver cancer
  • 万方数据
    中华普通外科杂志 중화보통외과잡지
    CHINESE JOURNAL OF GENERAL SURGERY
    2009年 12期 992-995 ,共4页

    陈勇%赵剑波%曾庆乐%何晓峰%卢伟%朱桥华%张克伟%黄得校%何凡%毛军杰%李彦豪

    진용%조검파%증경악%하효봉%로위%주교화%장극위%황득교%하범%모군걸%리언호

    癌%肝细胞%化学栓塞%治疗性%射频消融术%放射学%介入性 癌%肝細胞%化學栓塞%治療性%射頻消融術%放射學%介入性
    암%간세포%화학전새%치료성%사빈소융술%방사학%개입성
    Carcinoma,hepatoceUular%Chemoembolization,therapeutic%Radiofrequency%Radiology%interventional
    目的 探讨经皮穿刺瘤内注入碘油化疗药乳剂(CALE)治疗原发性肝癌的疗效和安全性.方法 本组57例患者中肝细胞癌49例,胆管细胞癌8例.共进行了90例次的治疗,即分90个靶区.术前均已行经动脉化疗栓塞术(55例)或化疗灌注术(2例).所有患者动脉造影均表现为少血供或不能插管人供血动脉者.在透视或者CT引导下,经皮穿刺注入CALE.术后1周内行X线平片或CT和实验室检查.术后1个月、3个月、6个月、1年随访,以后每6个月随访一次.残留灶复发者,行再次治疗.结果 57例原发性肝癌患者,行90例次治疗.均穿刺和注药成功,技术成功率为100%.靶区大小及CALE的用量为:肿瘤直径<3 cm者40例次,乳剂剂量3.0～7.0 ml;3～5 cm者43例次,乳剂剂量12.0～20 ml;>5 cm者7例次,乳剂剂量为24～40 ml.AFP阳性患者43例,治疗后14例降到正常范围.术后1个月CT显示CALE在靶区沉积良好者54例次(60.0%),欠佳者34例次(37.7%).缺失者2例次.随访2个月～6年,中位随访时间16个月.患者中位生存时间400 d.术后的主要副作用有:发热22例次(24.4%),恶心、呕吐等胃肠反应11例次(12.2%),穿刺部位疼痛17例次(18.9%),均自行缓解.结论 采用经皮穿刺瘤内注射CALE治疗原发性肝癌是有效和安全的.
    목적 탐토경피천자류내주입전유화료약유제(CALE)치료원발성간암적료효화안전성.방법 본조57례환자중간세포암49례,담관세포암8례.공진행료90례차적치료,즉분90개파구.술전균이행경동맥화료전새술(55례)혹화료관주술(2례).소유환자동맥조영균표현위소혈공혹불능삽관인공혈동맥자.재투시혹자CT인도하,경피천자주입CALE.술후1주내행X선평편혹CT화실험실검사.술후1개월、3개월、6개월、1년수방,이후매6개월수방일차.잔류조복발자,행재차치료.결과 57례원발성간암환자,행90례차치료.균천자화주약성공,기술성공솔위100%.파구대소급CALE적용량위:종류직경<3 cm자40례차,유제제량3.0～7.0 ml;3～5 cm자43례차,유제제량12.0～20 ml;>5 cm자7례차,유제제량위24～40 ml.AFP양성환자43례,치료후14례강도정상범위.술후1개월CT현시CALE재파구침적량호자54례차(60.0%),흠가자34례차(37.7%).결실자2례차.수방2개월～6년,중위수방시간16개월.환자중위생존시간400 d.술후적주요부작용유:발열22례차(24.4%),악심、구토등위장반응11례차(12.2%),천자부위동통17례차(18.9%),균자행완해.결론 채용경피천자류내주사CALE치료원발성간암시유효화안전적.
    Objective To evaluate percutaneous intratumoral injection of chemotherapeutic agents lipiodol emulsion (CALE) for the treatment of primary liver cancer. Methods This study included 57 patients of hepatocellular carcinoma (n=49) and intrahepatic cholangiocarcinoma (n=8).53 were male and 4 were female,with a mean age of 48.02 years(range,19～70 years).In all,ninety CALE injections were assigned to 90 target areas within the lesions.Before the procedures,transcathetcr arterial chemoembolization (n=55) or infusion (n=2) was carried out in these patients.By arteriography,low blood supply of target areas was showed or it was concluded that superselective catheterization of supply arteries of lesions could not accomplished.Percutaneous intratumoral CALE injection was carried out under fluoroscopy or CT guidance.Therapeutic effect,side effect and complications were assessed based on clinical manifestation,laboratory examination and fluoroscopy or CT one week after procedure.Follow-up was carried out after 1,3,6 months and 1 year,and once every six months thereafter.Local recurrences were treated according to patients'will.Results 90 sessions of percutaneous injection were successfully performed on 57 patients,with 100% technique success rate.The volume of CALE iniected per session ranged 3.0-7.0 ml(mean,6.0 ml) in target size less than 3 cm,12.0-20 ml(mean,15 ml)in target size of 3-5 cm and 24-40 ml in target larger than 5 cm.Serum AFP was positive in 43 patients and decreased to normal in 14 patients(28%).54 lesions(60%)were with well distribution of the lipiodol-chemotherapy mixture on CT 1 month after procedure.Follow-up ranged from 2 months to six years(mean,16 months).The median survival time was 400 d.The cumulative survival rates at 200 d,600d was 85%and 30%,respectively.Complications included fever (n=22,24.4%),nausea and vomit(n=11,12.2%),and pain at the puncture site (n=17,18.9%).Conclusions Percutaneous intratumor CALE injection is safe and effective for the treatment of primary liver cancer.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문