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目的:探讨CT导引瘤内注射乙酸治疗原发性肝癌的治疗效果。方法:在CT导引下直接瘤内注射乙酸治疗原发性肝癌患者46例,61个病灶,其中肿瘤D≤3cm者14个,3cm5cm者11个,多发肿瘤者10例(2~4个)。46例61个肿瘤CT导引PAI治疗145次。随访时间5~48个月,多次复查CT,动态观察肿瘤坏死情况,记录HCC患者的临床资料、存活时间、肝肾功能、AFP值等。结果:46例61个肿瘤145次穿刺成功率100%;肿瘤坏死率为71%~100%;直径≤3cm的小肝癌1、23、、4年的生存率分别为100%(12/12)、92%(11/12)、83%(10/12)、67%(8/12)(P<0.05);直径≤5cm者1、23、、4年的生存率分别为89%(24/27)、78%(21/27)、67%(18/27)、44%(12/27)(P<0.05);直径>5cm者12、年的生存率分别为29%(2/7)、14%(1/7)(P<0.05)。主要并发症为局限性腹膜炎、化学性胸膜炎(少量胸腔积液)、气胸,无严重的毒副作用和并发症。结论:CT引导下经皮穿刺直接瘤体内注射乙酸治疗单结节、无转移的小肝癌是一种疗效可靠、经济的微创性治疗技术。
Objective: To investigate the therapeutic effect of CT guided tumor injection of acetic acid in the treatment of primary liver cancer. Methods: Totally 46 patients with primary liver cancer and 61 lesions were treated with CT directly under intratumoral injection of acetic acid, including 14 tumors with D≤3cm, 36 with 3cm 5cm, Multiple tumors in 10 cases (2 to 4). 46 cases of 61 tumor CT guided PAI treatment 145 times. The follow-up time ranged from 5 to 48 months. The patients underwent CT examination repeatedly to observe the tumor necrosis and record the clinical data, survival time, liver and kidney function, AFP value of HCC patients. Results: The success rate of puncturing 145 lesions in 46 cases was 100%. The tumor necrosis rate was 71% -100%. The survival rates at 1, 23, 4 years of small hepatocellular carcinoma with diameter less than 3 cm were 100% (12/12) , 92% (11/12), 83% (10/12) and 67% (8/12) respectively (P <0.05). The survival rates at 1, 23, /27),78%(21/27),67%(18/27),44%(12/27)(P<0.05); those with diameter> 5cm had a 12-year survival rate of 29% (2 / 7), 14% (1/7) (P <0.05). The main complications of localized peritonitis, chemical pleurisy (a small amount of pleural effusion), pneumothorax, no serious side effects and complications. Conclusion: CT guided percutaneous direct injection of acetic acid in the treatment of single nodular non-metastatic small hepatocellular carcinoma is a reliable and economical minimally invasive treatment.