经皮乙醇注射治疗肝细胞癌。评估实践与并发症发生率的多中心调查。

Percutaneous ethanol injection in the treatment of hepatocellular carcinoma. A multicenter survey of evaluation practices and complication rates.

作者信息

Di Stasi M, Buscarini L, Livraghi T, Giorgio A, Salmi A, De Sio I, Brunello F, Solmi L, Caturelli E, Magnolfi F, Caremani M, Filice C

机构信息

Gastroenterology Division, Hospital of Piacenza, Italy.

出版信息

Scand J Gastroenterol. 1997 Nov;32(11):1168-73. doi: 10.3109/00365529709002998.

DOI:10.3109/00365529709002998

PMID:9399400

Abstract

BACKGROUND

Percutaneous ethanol injection (PEI) has become a widely used procedure in the treatment of hepatocellular carcinoma (HCC). However, the criteria for selecting patients are not standardized, and little information is available about the complications of the procedure.

METHODS

A questionnaire was sent to 11 experienced Italian centers. It investigated: the size and the number of HCC nodules suitable for treatment and the Child-Pugh risk class of the associated cirrhosis; the performance of the procedure; the number and characteristics of the patients treated; and, finally, any complications.

RESULTS

Most of the centers performed PEI in single HCC nodules less than 5 cm in diameter or in multiple nodules if fewer than three, the larger being less than 3 cm. Patients in Child-Pugh's classes A, B, and C with single nodules were generally considered for PEI. A prothrombin time of less than 40% and a platelet count of less than 40,000/mm3 contraindicated PEI in most of the centers. PEI was generally performed on outpatients, using Chiba or spinal needles. One thousand and sixty-six patients (8118 sessions) were enrolled; 74% had a single HCC nodule and 26% multiple nodules. All except four had cirrhosis; 53% were in Child class A, 38% in class B, and 9% in class C. The mean number of sessions needed to destroy an HCC nodule was 6.7 (range, 2-14), with a mean alcohol injection volume of 5.0 ml per session (range, 2-20 ml). One death (0.09%) and 34 complications (3.2%) were reported. Among the complications we call attention to the hemorrhagic ones (eight cases) and tumoral seeding (seven cases). Severe pain experienced during the maneuver led to discontinuation of the procedure in 3.7% of the patients; 13.5% of the patients required analgesics and 24% had fever after PEI.

CONCLUSIONS

Some procedural aspects of PEI treatment differ among the various centers a standardization is advisable. In the present survey PEI is a low-risk technique.

摘要

背景

经皮乙醇注射（PEI）已成为治疗肝细胞癌（HCC）广泛应用的方法。然而，患者选择标准并不统一，且关于该操作并发症的信息较少。

方法

向11个经验丰富的意大利中心发放了问卷。调查内容包括：适合治疗的HCC结节大小和数量以及相关肝硬化的Child-Pugh风险等级；操作情况；接受治疗患者的数量和特征；最后是任何并发症情况。

结果

大多数中心对直径小于5 cm的单个HCC结节或数量少于3个且最大直径小于3 cm的多个结节进行PEI。Child-Pugh A、B、C级的单个结节患者通常被考虑进行PEI。在大多数中心，凝血酶原时间低于40%和血小板计数低于40,000/mm³是PEI的禁忌证。PEI一般在门诊患者中进行，使用千叶针或脊椎针。共纳入1066例患者（8118次治疗）；74%为单个HCC结节，26%为多个结节。除4例患者外均有肝硬化；53%为Child A级，38%为B级，9%为C级。破坏一个HCC结节所需的平均治疗次数为6.7次（范围2 - 14次），每次平均乙醇注射量为5.0 ml（范围2 - 20 ml）。报告了1例死亡（0.09%）和34例并发症（3.2%）。在并发症中，我们关注出血性并发症（8例）和肿瘤种植（7例）。操作过程中出现的剧烈疼痛导致3.7%的患者治疗中断；13.5%的患者需要使用镇痛药，24%的患者在PEI后出现发热。