Tesdal I Kaare, Wikström Mats, Flechtenmacher Christa, Filser Thomas, Dueber Christoph
Department of Clinical Radiology, Universitätsklinikum Mannheim, Mannheim, Germany.
Cardiovasc Intervent Radiol. 2006 Sep-Oct;29(5):778-84. doi: 10.1007/s00270-005-0063-7.
To assess the role of transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in patients with hepatocellular carcinoma (HCC) and transjugular intrahepatic portosystemic shunts (TIPS).
Between January 1999 and September 2004, 6 patients with HCC and TIPS were treated with either TACE (n = 3) or TACE in combination with PEI (n = 3). One patient had a known advanced, untreated HCC prior to TIPS. In the remaining 5 patients HCC was diagnosed 14, 17, 51, 69, and 76 months respectively after elective TIPS. TACE was performed using a mixture of 30-60 mg of epirubicin and 10 ml of lipiodol following superselective catheterization of tumor-feeding vessels. PEI was performed under CT guidance.
The mean follow-up time after treatment of HCC was 26.2 months (range 7-46 months). During follow-up, all patients were free of rebleeding. Two patients died 7 and 38 months after one session of TACE and PEI (77 months after TIPS) and three sessions of TACE (91 months after TIPS), respectively. The cause of death was liver failure (Child-Pugh class C) and peritonitis, respectively. A third patient underwent liver transplantation 24 months after TIPS and several sessions of TACE. In the remaining 3 patients, the HCC is well controlled 13, 30, and 46 months after repetitive percutaneous treatment without signs of hepatic deterioration or metastasis.
Transcatheter arterial superselective chemoembolization and percutaneous ethanol injection seems to be beneficial even in HCC patients treated with TIPS, provided that the liver function is adequate.
评估经动脉化疗栓塞术（TACE）和经皮乙醇注射术（PEI）在肝细胞癌（HCC）合并经颈静脉肝内门体分流术（TIPS）患者中的作用。
1999年1月至2004年9月期间，6例HCC合并TIPS患者接受了TACE治疗（n = 3）或TACE联合PEI治疗（n = 3）。1例患者在TIPS术前已确诊为晚期未治疗HCC。其余5例患者分别在择期TIPS术后14、17、51、69和76个月被诊断为HCC。在对肿瘤供血血管进行超选择性插管后，使用30 - 60 mg表柔比星和10 ml碘油的混合物进行TACE。PEI在CT引导下进行。
HCC治疗后的平均随访时间为26.2个月（范围7 - 46个月）。随访期间，所有患者均未再出血。2例患者分别在一次TACE和PEI治疗后7个月和38个月（TIPS术后77个月）以及三次TACE治疗后（TIPS术后91个月）死亡。死亡原因分别为肝衰竭（Child - Pugh C级）和腹膜炎。第3例患者在TIPS术后24个月及多次TACE治疗后接受了肝移植。在其余3例患者中，经反复经皮治疗后，HCC在13、30和46个月时得到良好控制，无肝脏恶化或转移迹象。
即使在接受TIPS治疗的HCC患者中，只要肝功能足够，经动脉超选择性化疗栓塞术和经皮乙醇注射术似乎也是有益的。
