Angiographic subsegmentectomy for the treatment of patients with small hepatocellular carcinoma
Angiographic subsegmentectomy for the treatment of patients with small hepatocellular carcinoma
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DOI：
10.1002/cncr.11106
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发表时间：
2003-02-15
期刊：
影响因子：
6.2
通讯作者：
Okuda, K
中科院分区：
文献类型：
--
作者：
Iwamoto, S;Sanefuji, H;Okuda, K
背景资料。肝细胞癌的非手术治疗效果一直较差，需要改进治疗方法。作者最近开发了一种治疗小肝癌的新技术，称为血管造影亚段切除术。方法该技术包括利用螺旋CT扫描结合血管造影系统识别供瘤的亚段肝动脉，注射含有阿霉素的碘油，直到其足量进入门静脉，并将海绵颗粒注入肝动脉进行栓塞。用凝胶颗粒阻断肝动脉，用碘化油阻断门静脉，导致梗塞坏死，包括整个肿瘤和周围的肝实质。结果23例30个最大直径为20 mm的肝细胞癌患者接受了这种治疗。23例患者均获成功。大多数患者治疗后血清丙氨酸氨基转移酶水平升高至显著水平，3例患者出现轻度腹水，治疗后患者主诉疼痛和发热，这些患者很容易得到控制。无一例发生肝功能衰竭。仅1例患者在治疗后1.5年出现复发，1年复发率为5%，1.5年复发率为6.6%，这是其他治疗方式从未达到的复发率。结论：血管造影术是治疗小肝癌的一种新方法。结果表明，动脉化疗栓塞术与小切除术式相当，优于传统的动脉化疗栓塞术。
BACKGROUND. The therapeutic results of nonsurgical treatment for patients with hepatocellular carcinoma (HCC) have been poor, and improved treatments are needed. The authors recently developed a new technique called angiographic subsegmentectomy for the treatment of patients with small HCC.METHODS. The technique includes confirming the diagnosis of small HCC using a helical computed tomography (CT) scan combined with an angiography system for identifying the tumor-feeding subsegmental hepatic artery, injecting lipiodol containing farmorubicin until it enters the portal vein in sufficient amounts, and injecting sponge particles into the hepatic artery for embolization. Occlusion of the hepatic artery with gel particles and occlusion of the portal vein by lipiodol induce infarction necrosis, which encompasses the entire tumor and the surrounding liver parenchyma.RESULTS. The treatment was given to 23 patients with 30 HCC tumors that measured < 20 mm in greatest dimension. It was successful in all 23 patients. Serum alanine aminotransferase levels were elevated to a significant level in the majority of patients after treatment, mild ascites developed in three patients, and the patients complained of pain and fever posttreatment that were controlled readily. No patients developed hepatic failure. Only one patient developed recurrent disease posttreatment at 1.5 years, for a recurrence rate of 5% at 1 year and 6.6% at 1.5 years, a rate that has never been achieved with other treatment modalities.CONCLUSIONS. Angiographic subsegmentectomy is a novel treatment for patients with small HCC. The results indicated that it is equivalent to undergoing small resection and is superior to conventional arterial chemoembolization.