Livraghi T
Servizio di Radiologia, Ospedale Civile, Vimercate, Milan, Italy.
Hepatogastroenterology. 2001 Jan-Feb;48(37):20-4.
BACKGROUND/AIMS: In this study we discuss and evaluate the use of percutaneous ethanol injection for the treatment of hepatocellular carcinoma in cirrhosis.
Percutaneous ethanol injection was performed under ultrasound guidance, with multiple sessions at an outpatient department or with "single-session" technique under general anesthesia, according to the size and number of the lesions.
In our patients with Child A (293), B (149), or C (20) cirrhosis and single hepatocellular carcinoma 5 cm or smaller, the 1-, 3- and 5-year survival rates were 98, 79 and 47%, 93, 63 and 29%, and 64, 12 and 0%, respectively. In our 108 patients with larger hepatocellular carcinoma, 1- and 3-year survival rates were: 72 and 57% in single, encapsulated tumors, 73 and 42% in single infiltrating or multiple encapsulated tumors, and 46 and 0% in symptomatic or with advanced portal thrombosis tumors.
Percutaneous ethanol injection proved to be a safe, effective, repeatable, easy and low-cost therapy for hepatocellular carcinoma. Survival after percutaneous ethanol injection was comparable to that after surgical resection, probably because of a balancing between greater complete ablation rate of surgery versus absence of early mortality and liver damage of percutaneous ethanol injection. On the basis of the percutaneous ethanol injection rationale, other ablation techniques were proposed using radiofrequency, laser or acetic acid. Their initial results are promising.
背景/目的：在本研究中，我们讨论并评估经皮乙醇注射治疗肝硬化肝细胞癌的应用。
根据病变的大小和数量，在超声引导下进行经皮乙醇注射，在门诊进行多次注射，或在全身麻醉下采用“单次注射”技术。
在我们患有Child A（293例）、B（149例）或C（20例）级肝硬化且单个肝细胞癌直径5厘米或更小的患者中，1年、3年和5年生存率分别为98%、79%和47%，93%、63%和29%，以及64%、12%和0%。在我们的108例较大肝细胞癌患者中，单个包膜完整肿瘤的1年和3年生存率分别为72%和57%，单个浸润性或多个包膜完整肿瘤的为73%和42%，有症状或伴有门静脉血栓形成晚期肿瘤的为46%和0%。
经皮乙醇注射被证明是一种安全、有效、可重复、简便且低成本的肝细胞癌治疗方法。经皮乙醇注射后的生存率与手术切除后的生存率相当，这可能是因为手术的完全消融率更高与经皮乙醇注射无早期死亡率和肝损伤之间达到了平衡。基于经皮乙醇注射的原理，人们提出了使用射频、激光或乙酸的其他消融技术。它们的初步结果很有前景。
