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目的 探讨大剂量碘油肝动脉栓塞化疗治疗巨块型原发性肝癌的方法和疗效。方法使用Seldinger方法 ,经股动脉做肝动脉栓塞化疗治疗肝癌 ,超液化碘油 (lipiodol)的单次剂量为 2 0～ 5 3ml。结果 共有 16 3例患者接受大剂量碘油栓塞化疗 ,对ChildA级或吲哚靛青绿 15min滞留率 (ICG R15 ) <2 0 %者 ,肝功能损害不大。术后CT碘油在瘤内的分布以完全型 (Ⅰ型 )和缺损型 (Ⅱ型 )多见。肝功能为ChildA级者 ,其 1,2 ,3年生存率为 79 8%、5 0 3%和 38 5 % ,较常规剂量组高 (P =0 0 136 )。结论 大剂量碘油肝动脉栓塞化疗治疗肝癌切实可行 ,疗效优于常规剂量的介入治疗。建议对肝功能分级为ChildA级或ICG R15 <2 0 %、肝右叶血管丰富的巨块型肝癌 ,采用 2 0～ 40ml的大剂量碘油栓塞治疗 ,以使瘤床血管完全填塞 ,得到最佳栓塞效果。
Objective To explore the method and efficacy of large dose lipiodol hepatic artery embolization chemotherapy for massive hepatocellular carcinoma. Methods Seldinger method was used to treat hepatocellular carcinoma with hepatic artery embolization chemotherapy through femoral artery. The single dose of lipiodol was 20-53 ml. RESULTS: A total of 163 patients were treated with large doses of lipiodol embolization, and liver function impairment was not significant for ChildA grade or indocyanine green 15min retention rate (ICG R15) <20%. Postoperative CT lipiodol distribution in the tumor was more common in type I and defect type II. Liver function was Child A grade, and the 1, 2 and 3 year survival rates were 79 8%, 50 3%, and 38.5%, which was higher than the conventional dose group (P =0 0 136 ). Conclusion High-dose iodized hepatic artery embolization chemotherapy is feasible and effective in the treatment of liver cancer, and its curative effect is superior to conventional dose interventional therapy. It is recommended that hepatic function be graded as Child A grade or ICG R15 <20%, and the hepatic lobes with abundant right hepatic vessels should be treated with a large dose of 20-100 ml lipiodol embolization to completely fill the tumor bed blood vessels. Good embolization effect.