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目的 探讨99m锝 MAA(99mTechnetium macroaggregatedalbumin ,99mTc MAA)肝动脉造影在经肝动脉灌注32 磷 玻璃微球 (32 P GMS)治疗手术不能切除的肝细胞癌 (HCC)中的价值。方法 对 2 8例手术证实不能切除的HCC经皮下埋藏药盒行99mTc MAA肝动脉造影 ,测定肺肝分流比 (Lu/Li)和癌 /肝放射比 (T/N) ,并对其中 18例行经肝动脉灌注32 P GMS选择性内放射治疗 (SIRT)。结果 本组99mTc MAA肝动脉造影测定Lu/Li为 7%± 7% (1%～ 2 5 % ) ,T/N为 5± 3(1～ 14) ;接受SIRT治疗的 18例Lu/Li为 4%± 2 % (1%～ 8% ) ,T/N为 4± 2 (1～ 8) ,其中 15例T/N大于或等于 2 ,3例小于 2。无治疗死亡及严重并发症 ,有效率 6 1% (11/ 18) ,中位生存期 5 5个月 ,术后 3、6、9、12个月生存率分别为 94%、47%、34%和 2 7% ;其中T/N大于或等于 2者中位生存期优于T/N小于 2者 ,分别为 6 6个月和 4 1个月 (P =0 0 11) ,Child′sA级中位生存期优于B级者 ,分别为 9 9个月和 3 8个月 (P =0 0 0 4)。结论 99mTc MAA肝动脉造影是选择性内放射治疗HCC的一项重要措施 ,有助于选择合适病例、提高疗效和避免严重并发症的发生。
Objective To investigate the value of 99m锝 MAA (99mTechnetium macroaggregated alummin, 99mTc MAA) hepatic artery angiography in hepatic artery perfusion of 32-phospho-glass microspheres (32 P GMS) in the treatment of unresectable hepatocellular carcinoma (HCC). METHODS: Twenty-eight patients with unresectable HCC who underwent surgical resection were subjected to 99mTc MAA hepatic arteriography. The ratio of pulmonary liver shunt (Lu/Li) and cancer/hepatic radiology (T/N) were measured. 18 of them were performed. Hepatic artery perfusion of 32 P GMS selective internal radiation therapy (SIRT). Results In this group 99mTc MAA hepatic arteriography was used to measure Lu/Li of 7%±7% (1% to 25%) and T/N of 5±3 (1 to 14). 18 cases of Lu/Li treated with SIRT were included. 4% ± 2% (1% ~ 8%), T / N is 4 ± 2 (1 ~ 8), of which 15 cases of T / N greater than or equal to 2, 3 cases less than 2. No treatment death and serious complications, the effective rate was 6 1% (11/18), the median survival period was 55 months, and the postoperative survival rates at 3, 6, 9, and 12 months were 94%, 47%, and 34, respectively. % and 2 7%; those with T/N greater than or equal to 2 had better median survival than those with T/N less than 2, which were 6 6 months and 41 months respectively (P =0 0 11). Child’s A The median survival time was better than that of the B class, which was 9 9 months and 38 months respectively (P =0 04). Conclusion 99mTc MAA hepatic arteriography is an important measure for the selective internal radiation therapy of HCC, which helps to select suitable cases, improve the efficacy and avoid serious complications.