Percutaneous Ethanol Injection Therapy for Liver Neoplasms
Percutaneous Ethanol Injection Therapy for Liver Neoplasms
复制标题
经皮乙醇注射治疗肝肿瘤
DOI：
10.1055/s-2008-1074708
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发表时间：
1993
影响因子：
1.4
通讯作者：
M. Omata
中科院分区：
文献类型：
--
作者：
S. Shiina;Y. Niwa;M. Omata
经皮乙醇注射疗法（PElT）由Sugiura等人于1983年首次报道，已被广泛应用于肝脏肿瘤的治疗，尤其是肝细胞癌（HCC）治疗后的组织病理学检查显示，在大多数情况下，PElT可以完全摧毁肿瘤随后的影像学研究和血清肿瘤标志物分析证实了这种方法的显著抗癌效果。此外，PElT具有令人印象深刻的长期存活率引入PElT有三个因素。首先，没有令人满意的HCC治疗方法。虽然通过对肝炎病毒携带者和慢性肝病患者等高危人群的筛查，发现了越来越多的亚临床hcc病例，但这种癌症的可切除率非常低。例如，根据日本肝癌研究小组的最新报告，10082例hcc中只有3065例（30.4%）被切除。大多数HCC患者在诊断时已经有肝内转移，或者肝硬化继发的严重肝功能障碍往往使得即使在早期HCC患者也无法进行肝切除术。此外，即使在治愈性切除病变后，癌症也经常复发。‘5-’7经导管动脉栓塞术在治疗不可切除的肝细胞癌中得到了广泛应用，并取得了显著的效果。18,19然而，经导管栓塞在许多病例中不能治愈，因为它对囊内、囊外或血管侵入无效此外，在小HCCs2O治疗中，其抗癌作用可能被抵消，因为栓塞似乎损害了非癌性肝实质。对于无法切除的病例，人们尝试了各种化疗方法。然而，无论何种药物类型和给药途径，结果都不令人满意因此，HCC治疗方法的发明可以治愈且不损害非癌性肝实质。第二个因素是超声检查技术的进步，这使得经皮穿刺针头精确而安全地进入腹部器官成为可能。本文介绍了多种超声引导下的治疗方法，如梗阻性黄疸的经皮肝胆引流和经皮脓肿引流第三，无水乙醇已广泛应用于各种治疗过程，如肾肿瘤的经导管动脉栓塞，食管静脉曲张的血栓治疗，继发性甲状旁腺功能亢进的经皮注射在超声观察下，将无水乙醇通过细针注入病灶内。
Percutaneous ethanol injection therapy (PElT), which was first reported by Sugiura et al in 1983,' has been widely performed in the treatment of liver neoplasms, especially hepatocellular carcinoma (HCC).25 Histopathologic examinations after the therapy have revealed that PElT can destroy the tumor completely in most cases.8 Follow up imaging studies and serum tumor marker assays have attested to the remarkable anticancer effect of this procedure.9'° In addition, PElT has resulted in impressive long-term survival rates.12 There were three factors in the introduction of PElT. First, there were no satisfactory therapies for HCC. Although more and more cases of subclinical HCCs are being found by screening of high-risk subjects such as hepatitis virus carriers and patients with chronic liver disease,'3 the resectability rate of this cancer is strikingly low. For example, according to' the latest report of The Liver Cancer Study Group of Japan, only 3065 of 10,082 HCCs (30.4%) were resected.'4 Most patients with HCC already have intrahepatic metastases at the time of diagnosis, or severe liver dysfunction secondary to cirrhosis often makes hepatectomy impossible even in early HCCs. Also, the cancer very frequently recurs, even after curative resection of the lesion.'5-'7 Transcatheter arterial embolization has been widely used and has achieved remarkable results in the treatment of unresectable HCCs.18,19 However, transcatheter embolization cannot be curative in many cases because of its ineffectiveness against intercapsular, extracapsular, or vascular invasion.19 In addition, its anticancer effect may be canceled out in the treatment of small HCCs2O because the embolization seems to damage noncancerous liver parenchyma.2' Various types of chemotherapy have been tried in unresectable cases. However, regardless of the types of agents and the routes of administration, the results have not been satisfactory.22 Thus, invention of therapies for HCC that could be curative and did not damage noncancerous liver parenchyma evolved. A second factor was the improvements in ultrasonography that made it possible to guide needles percutaneously into abdominal organs precisely and safely. Various therapeutic procedures using ultrasound guidance were introduced, such as percutaneous transhepatic bile drainage for obstructive jaundice23 and percutaneous abscess drainage.24 Third, absolute ethanol has been widely used in various therapeutic procedures, such as transcatheter arterial embolization of renal tumors,25 thrombotherapy of esophageal varices,26 and percutaneous injection in secondary hyperparathyroidism.27 In PElT, absolute ethanol is injected into lesions through fine needles under ultrasonographic observation.