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目的探讨经动脉超选择性灌注无水酒精联合常规TACE治疗巨块型肝癌的可行性和临床意义。方法对16例巨块型肝癌者行超选择性插管至肿瘤动脉内或入口处,经导管交替灌注碘油化疗药乳剂和无水酒精。观察肿瘤栓塞和坏死程度及肿瘤血管复通情况。结果16例患者共超选择性插管并灌注无水酒精27支肿瘤动脉,无水酒精用量3～23ml,平均9.2ml。肿瘤的完全栓塞率50%(8/ 16)明显比对照组25%(5/20)高,而血管复通率62.5%(10/16)则比对照组90%(18/20)低。碘油用量与对照组比较,平均可减小51%。16例患者除2例因无水酒精灌注量少(不足5ml)外,其余患者在无水酒精灌注区域均可见不同程度的蜂窝状坏死。结论经动脉瘤内灌注无水酒精,可直接杀死肿瘤细胞,促进肿瘤坏死,并可直接破坏和栓塞肿瘤血管,增加肿瘤的栓塞效果,且肿瘤血管不易复通。
Objective To investigate the feasibility and clinical significance of transarterial selective perfusion of anhydrous alcohol in combination with conventional TACE in the treatment of massive liver cancer. Methods Sixteen patients with giant hepatocellular carcinoma underwent selective catheterization into the artery or the entrance of the tumor. The animals were anesthetized by lipiodol chemiluminescence and dehydrated alcohol. Observe the extent of tumor embolism and necrosis and tumor vascular recanalization. Results Twenty-six patients underwent a total of 27 arterial infusions of superficially cannulated and perfused alcohol. The dosage of anhydrous alcohol was 3 ~ 23ml with an average of 9.2ml. The complete embolization rate of tumor was 50% (8/16) significantly higher than 25% (5/20) in control group, while the rate of vascular recanalization was 62.5% (10/16) lower than 90% (18/20) in control group. Lipiodol consumption compared with the control group, the average can be reduced 51%. 16 patients except for 2 cases of ethanol perfusion less (less than 5ml), the remaining patients in the area of anhydrous alcohol infusion were seen varying degrees of honeycomb necrosis. Conclusion Aneurysm perfusion with anhydrous alcohol can directly kill tumor cells, promote tumor necrosis, and can directly destroy and embolize the tumor blood vessels, increasing the embolization effect of the tumor, and the tumor vessels are not easy to pass through.