Kisilevzky N, dos Anjos L C, Carnevale F, de Souza C M, Mott C de B, Laudana A, Magalhães A C
Serviço de Radiologia Intervencionista, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo.
Rev Hosp Clin Fac Med Sao Paulo. 1995 Jul-Aug;50(4):236-9.
Clinical manifestation of carcinoide syndrome are often difficult to control with medical treatment and so present a large problem for doctors. In the majority of cases, such manifestations are seen in patients with hepatic metastases. In such cases the control of the problem can be achieved by local hepatic treatment. A 57 year old patient with carcinoide syndrome for a year, with extensive hepatic tumor from a carcinoide tumor, whose origins were not lokted, had a urinary excretion 5-hidroxi-indolacetic = 73 mg in 24 hours, he used cyproheptadin, loperamida and metisergida without showing improvement. In light of the failure of medical treatment and the impossibility of surgery he was given into hepatic chemoembolization (QEH) with lipiodol, doxorrubicin (1.0 mg/Kg) and mitomicin (10.0 mg) twice. Clinical control with absolute recovery of "flushing" and diarrhea were achieved, a dose of 5-HIAA U (5.5 mg) after the first application. Transitory alterations of the aminotransferasis alkaline phosphates and leucocytosis. Besides the post embolization syndrome that regressed in 20 days, there were no complications recurring after treatment. The period of recovery was more than 9 months. We can then conclude that hepatic chemoembolization is an efficient treatment to control carcinoid syndrome.
类癌综合征的临床表现往往难以通过药物治疗得到控制,因此给医生带来了很大的问题。在大多数情况下,此类表现见于有肝转移的患者。在这种情况下,可以通过局部肝脏治疗来控制问题。一名57岁的患者患有类癌综合征一年,患有起源不明的类癌肿瘤导致的广泛肝肿瘤,其24小时尿5-羟吲哚乙酸排泄量为73毫克,他使用了赛庚啶、洛哌丁胺和麦角苄酯但未见改善。鉴于药物治疗失败且无法进行手术,他接受了两次用碘油、阿霉素(1.0毫克/千克)和丝裂霉素(10.0毫克)进行的肝动脉化疗栓塞术(QEH)。实现了临床控制,“潮红”和腹泻完全恢复,首次治疗后5-羟吲哚乙酸水平降至5.5毫克。出现了转氨酶、碱性磷酸酶短暂改变和白细胞增多。除了在20天内消退的栓塞后综合征外,治疗后没有并发症复发。恢复时间超过9个月。因此我们可以得出结论,肝动脉化疗栓塞术是控制类癌综合征的一种有效治疗方法。