全身麻醉下超声引导经皮乙醇注射治疗肝硬化合并肝细胞癌：268例患者的长期结果

Ultrasound-guided percutaneous ethanol injection under general anesthesia for the treatment of hepatocellular carcinoma on cirrhosis: long-term results in 268 patients.

作者信息

Giorgio A, Tarantino L, de Stefano G, Perrotta A, Aloisio V, del Viscovo L, Alaia A, Lettieri G

机构信息

Interventional Ultrasound Service, 'D. Cotugno' Hospital, Via Quagliariello 54, 80131, Naples, Italy.

出版信息

Eur J Ultrasound. 2000 Dec;12(2):145-54. doi: 10.1016/s0929-8266(00)00113-0.

DOI:10.1016/s0929-8266(00)00113-0

PMID:11118922

Abstract

OBJECTIVE

Percutaneous ethanol injection (PEI) under general anesthesia (One-shot PEI) is a therapy for large and multiple hepatocellular carcinoma (HCC) by the injection of a large amount of ethanol into the tumor. We report our results with 5-year survival rates in patients with HCC on cirrhosis treated with One-shot PEI.

PATIENTS AND METHODS

From October 1992 to March 1998, 268 cirrhotic patients (age 42-82 years; 191 males; 95 Child-Pugh's A class, 150 B and 23 C class of cirrhosis) with 515 HCC nodules underwent One-shot PEI. Diameter of HCC nodules ranged from 0.6 to 14 cm (mean 5.02 +/- 2.2 cm; median: 4 cm). One hundred and thirty-eight patients had a single nodule (range 3.2-14 cm; mean 5.6 +/- 2.1 cm), 130 had multiple nodules, up to six nodules (mean 2.9 nodules) (range 0.6-11 cm; mean 4.8 +/- 2.1 cm)

RESULTS

CT showed complete necrosis in 357/506 nodules (70%). Five patients (1.8%) with nine nodules died as a result of the procedure (variceal bleeding in three cases, liver failure in one and hemoperitoneum in one). The overall survival rates were 93, 83, 74, 65 and 59% at 1, 2, 3, 4 and 5 years, respectively. Survival rates were 90, 84, 82 and 82% at 12, 24, 36 and 48 months, respectively, in patients with a single nodule less than or = 5 cm, and 97, 71, 59, 59 and 59% at 12, 24, 36, 48 and 60 months, respectively, in patients with single nodule >5 cm. Patients with multiple nodules had survival rates of 97, 89, 75, 60 and 60% at 12, 24, 36, 48 and 60 months, respectively.

CONCLUSION

PEI of large and multiple HCC showed survivals similar to conventional PEI for patients with smaller tumors.

摘要

目的

全身麻醉下经皮乙醇注射（一次性经皮乙醇注射）是一种通过向肿瘤内注射大量乙醇来治疗大的和多发性肝细胞癌（HCC）的方法。我们报告了接受一次性经皮乙醇注射治疗的肝硬化合并HCC患者的5年生存率结果。

患者与方法

1992年10月至1998年3月，268例肝硬化患者（年龄42 - 82岁；男性191例；Child-Pugh A级95例，B级150例，C级23例）共515个HCC结节接受了一次性经皮乙醇注射。HCC结节直径为0.6至14厘米（平均5.02±2.2厘米；中位数：4厘米）。138例患者有单个结节（范围3.2 - 14厘米；平均5.6±2.1厘米），130例有多个结节，最多6个结节（平均2.9个结节）（范围0.6 - 11厘米；平均4.8±2.1厘米）。

结果

CT显示506个结节中有357个（70%）完全坏死。9个结节的5例患者（1.8%）因该操作死亡（3例为静脉曲张出血，1例为肝功能衰竭，1例为腹腔积血）。1、2、3、4和5年的总生存率分别为93%、83%、74%、65%和59%。单个结节≤5厘米的患者在12、24、36和48个月时的生存率分别为90%、84%、82%和82%，单个结节>5厘米的患者在12、24、36、48和60个月时的生存率分别为97%、71%、59%、59%和59%。多个结节的患者在12、24、36、48和60个月时的生存率分别为97%、89%、75%、60%和60%。