大剂量碘油肝动脉栓塞化疗治疗巨块型肝癌

目的：探讨探讨大剂量碘油肝动塞化疗法巨块型原发性肝癌的方法和疗效。方法使用Seldinger方法，经股动脉做肝动塞化疗治疗肝癌，超液化碘油（lipiodol)的单次剂量为20－53ml，结果共3 163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）＜20％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％、50．3％和38．5％，较常规剂量组高（P＝0．0136）。结论大剂量碘油肝动脉栓塞化疗治疗肝癌切实可行，疗效优于常南剂量的介入治疗，建议对肝功能分级为ChilA级或ICG－R15＜20％、肝右叶血管丰富的巨块型肝癌、采用20－40ml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。

Transarterial chemoembolization with high dose iodized oil for the treatment of large hepatocellular carcinoma

OBJECTIVE: To report the method and result of high dose iodized oil chemoembolization for the treatment of large hepatocellular carcinoma. METHODS: From 1993 to 1998, 163 patients with unresectable hepatocellular carcinoma were treated by transarterial chemoembolization (TACE) with more than 20 ml lipiodol. RESULTS: TACE with high dose lipiodol was well tolerated by the treated patients. In patients whose liver function was of Child A stage, or in patients whose residual indocyanine green level 15 min after injection was less than 20%, the frequency of post-treatment hepatic insufficiency was not significantly different from that of patients treated with routine dose of lipiodol. On CT scan at 4 wk after TACE, more lipiodol was located in the liver. The 1-, 2-,3-year survival rate of patients in Child A stage was 79.8%, 50.3%, and 38.5%, respectively, as compared to 57.5%, 24.8% and 8.37%, respectively in patients treated with routine dose of lipiodol (P = 0.0136). CONCLUSION: High dose lipiodol TACE for the treatment of large hepatocellular carcinoma is practically acceptable with better therapeutic effect but its use should be limited to those patients with compensated liver function.