Ohnishi K, Yoshioka H, Kosaka K, Toshima K, Nishiyama J, Kameda C, Ito S, Fujiwara K
Third Department of Medicine, Saitama Medical School, Japan.
Am J Gastroenterol. 1996 Dec;91(12):2574-9.
To compare the efficacy of ultrasound-guided percutaneous acetic acid injection and segmental transcatheter arterial embolization for hypervascular small hepatocellular carcinoma.
The prognosis of 40 patients with one to three angiographically hypervascular hepatocellular carcinoma smaller than 3 cm in diameter treated with either percutaneous acetic acid injection (25 patients) or transcatheter arterial embolization (15 patients) during the past 4.5 yr were analyzed retrospectively.
After initial therapy, none of 25 patients treated with percutaneous acetic acid injection developed ascites, whereas 5 of 15 (33%) patients treated with transcatheter arterial embolization developed it (p < 0.01). All tumors became smaller once after each therapy. However, local recurrence (reenlargement of the original tumor) occurred in 1 of 29 (3%) tumors treated with percutaneous acetic acid injection and 11 of 22 (50%) tumors treated with transcatheter arterial embolization (p < 0.005). During the follow-up, 4 of 25 (16%) patients treated with percutaneous acetic acid injection and 10 of 15 (67%) patients treated with transcatheter arterial embolization died. The 1-, 2-, and 3-yr survival rate was 100, 94, and 83%, respectively, in patients treated with percutaneous acetic acid injection and 72, 65, and 39% in patients treated with transcatheter arterial embolization (p < 0.005). The cancer-free survival rate was also significantly better in the former than in the latter group (p < 0.005).
Percutaneous acetic acid injection is superior to segmental transcatheter arterial embolization in the treatment of hypervascular small hepatocellular carcinoma.
比较超声引导下经皮醋酸注射与节段性经导管动脉栓塞治疗富血管性小肝细胞癌的疗效。
回顾性分析过去4.5年中40例直径小于3 cm的一至三个血管造影显示为富血管性肝细胞癌患者的预后，其中25例接受经皮醋酸注射治疗，15例接受经导管动脉栓塞治疗。
初始治疗后，25例接受经皮醋酸注射治疗的患者均未出现腹水，而15例接受经导管动脉栓塞治疗的患者中有5例（33%）出现腹水（p<0.01）。每次治疗后所有肿瘤均有一次缩小。然而，经皮醋酸注射治疗的29个肿瘤中有1个（3%）发生局部复发（原肿瘤再次增大），经导管动脉栓塞治疗的22个肿瘤中有11个（50%）发生局部复发（p<0.005）。随访期间，25例接受经皮醋酸注射治疗的患者中有4例（16%）死亡，15例接受经导管动脉栓塞治疗的患者中有10例（67%）死亡。经皮醋酸注射治疗患者的1年、2年和3年生存率分别为100%、94%和83%，经导管动脉栓塞治疗患者的生存率分别为72%、65%和39%（p<0.005）。前一组的无癌生存率也显著高于后一组（p<0.005）。
在治疗富血管性小肝细胞癌方面，经皮醋酸注射优于节段性经导管动脉栓塞。
