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背景与目的:肺是肝癌肝外转移最常见的器官,对于原发灶控制稳定而仅有肺转移瘤的肝癌患者,转移瘤的治疗效果就成为决定预后的关键因素。本研究通过CT导向下无水乙醇瘤内注射治疗原发性肝癌肺转移瘤的疗效评估其临床价值。方法:2004年8月至2006年9月,在CT导向下对17例原发性肝癌术后或原发性肝癌TACE术后原发灶控制稳定的肺转移瘤患者的37个肺转移灶行经皮经肺瘤内无水乙醇注射治疗,8周后复查胸腹部CT评估其临床疗效。结果:胸腹部CT复查显示,37个肺内转移灶中31个病灶无增大,增强扫描病灶无强化,其中26个病灶瘤内无水乙醇沉积完全,5个病灶沉积良好;6个病灶复查见肿瘤增大或无水乙醇明显流失,增强后有明显强化。所有患者肝内未见复发或原发灶仍维持稳定。术后8周疗效评价有效率达到83.8%,1年生存率64.2%,有7例患者至今仍生存,最长者生存超过2年。仅2例患者术中发生气胸,肺压缩均在30%以内,经施行气胸引流后3天肺组织就完全复张,未发生其他并发症。结论:CT导向下无水乙醇瘤内注射治疗肝癌肺转移瘤创伤小、疗效确切、并发症少,值得临床推广应用。
BACKGROUND & OBJECTIVE: The lung is the most common organ for extrahepatic metastasis of HCC. For liver cancer patients with stable primary tumor metastases and lung metastases only, the therapeutic effect of metastases has become a key factor in determining prognosis. In this study, the clinical value of CT-guided intratumoral injection of ethanol in the treatment of primary hepatic carcinoma of lung metastases was evaluated. METHODS: From August 2004 to September 2006, 37 lung metastatic lesions were performed on CT-guided lung metastatic tumors with stable primary tumors after surgery for primary hepatocellular carcinoma or primary hepatocellular carcinoma in 17 patients. The epidermis was treated with intra-alcohol injection of ethanol. Eight weeks later, chest and abdomen CT was reviewed to evaluate its clinical efficacy. Results: CT examination of thorax and abdomen showed that 31 lesions in 37 lung metastases did not increase, and lesions in enhanced scans did not strengthen. Among them, absolute ethanol deposition was complete in 26 lesions, 5 lesions deposited well, and 6 lesions were reviewed. See tumor enlargement or significant loss of absolute ethanol, enhanced significantly. All patients had no recurrence in the liver or the primary tumor remained stable. Eight weeks after operation, the effective rate of evaluation reached 83.8%, and the one-year survival rate was 64.2%. Seven patients still survived, and the longest survived more than two years. Only 2 patients had intraoperative pneumothorax, and the lung compression was within 30%. After 3 days of pneumothorax drainage, the lung tissue completely resurfaced without any other complications. Conclusion: Intratumoral injection of ethanol under the guidance of CT guided the treatment of hepatomas and lung metastases of lung cancer with less trauma, definite curative effect and fewer complications. It is worthy of clinical application.