【作者】 李顺宗； 谷铁树； 李智岗； 赵俊京； 杨光； 黄景香；

【Author】 LI Shun-zong GU Tie-shu LI Zhi-gang ZHAO Jun-jing YANG Guang HUANG Jing-xiang (Department of Radiology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

【机构】 河北医科大学第四医院放射科；

【摘要】 目的探讨超选择性插管在胆管细胞型肝癌动脉灌注栓塞中的作用、疗效。方法所有病例先行间接门脉造影及腹腔动脉造影后,超选择组根据病变的大小、分布范围、血供情况,采取不同的动脉灌注及栓塞治疗,若病变较大,占据一个肝叶,其血供主要由一个肝叶动脉,则超选择行肝叶动脉灌注栓塞治疗;若病变较局限,主要由一个或几个肝段血管供血,则分别行一个或几个肝段动脉灌注栓塞治疗。既往非超选择性治疗组多行肝固有动脉灌注栓塞。灌注化疗方案及用量前后两种治疗组相同,超选择组和非超选择组均以在透视监视下碘油与化疗药混悬乳剂在靶血管内流速明显减慢同时非肿瘤血管内无明显血管铸形为标准。所有病例均常规于术前、介入术后3天、1周、1个月行肝功能检查,肝功能主要观测不同时期血清谷丙转氨酶(ALT)、总胆红素(TBIL)和白蛋白(ALB)等指标变化;1个月行肝脏CT平扫检查及血清甲胎蛋白(AFP)检查,观察肿瘤内碘油沉积情况及AFP的变化。并将上述观测指标进行列表分析同时进行统计学比较。结果 54例超选择组根据肿瘤大小部位及分布范围,进一步行肝段(29例)、肝叶动脉(25例)栓塞,比较非超选择组可明显增加肿瘤内碘油沉积量。所有病例介入手术后未出现明显术后并发症,术后复查及观测各项指标经统计学分析,超选择组血清谷丙转氨酶(ALT)和总胆红素(TBIL)灌注栓塞术后的变化明显小于非超选择组(P<0.05),白蛋白(ALB)两组比较无明显差异(P>0.05)两组碘油沉积有明显差异P<0.05)。结论超选择性插管在胆管细胞型肝癌介入治疗中有重要价值。更多还原

【Abstract】 Objective To probe the efficiency of superselective transcatheter arterial chemoembolization(STACE) in the treatment of Cholangiocellular carcinoma.Methods:First,all the cases received indirect portal vein angiography and abdominal arterial angiography,and then different TACE were used to superselective group,according to the size,the distribution and the blood supply of the carcinoma.If the carcinoma was bigger,occupying one hepatic lobes which is supplied by one hepatic lobes artery,we should apply STACE to the hepatic lobes.If the carcinoma’s scope is limited which was supplied by one or several hepatic segment arteries,we need use STACE to the hepatic segment arteries. Usually,proper hepatic arterial chemoembolization is applied to the prior non-superselective treatment group.The two groups the 49 cases were the same in schedule and dose.The standard of the two groups is the obviously flow down in the target vessel at the perspective monitor,using suspend emulsion of lipiodol and chemomedicine,but there was none obviously vessel proplasm in the vessel which is not supply to carcinoma.Routinly,hepatic function check must be done give to all the cases before the intervention therapy and three days,one week and one month after that.The main purpose is to monitor the charges of ALT,TBIL and ALB at different stages.Hepatic CT and detection of AFP in serum which is done every month is applied,and to charges of AFP in the carcinoma.After all the above work,make a table about the indexes and a statistics contrast.Results:According to the size,location and range of the carcinoma,the 54 cases superselective group which has done hepatic lobes arterial chemoembolization(29cases) and hepatic segment arterial chemoembolization(25cases) are compared to the non-superselective group.The result is the deposition in the latter is obviously increased.There is no apparent complication in all the cases after intervent operation.The charges of ALT,TBIL in the serum of superselective group is apparently less than the non-superselective group(P<0.05),according to recheck after operation and statistics analysis of the surveyed index,there is no obviously difference of ALB between the two groups(P>0.05),but the deposition of lipiodol has apparently different between the two group(P<0.05). Conclude:Superselective transcatheter arterial chemoemobolization have great important value in the treatment of cholangiocellular carcinoma.更多还原