全身麻醉下经皮乙醇注射治疗肝细胞癌：112例患者的3年生存率

Percutaneous ethanol injection under general anesthesia for hepatocellular carcinoma: 3 year survival in 112 patients.

作者信息

Giorgio A, Tarantino L, Mariniello N, de Stefano G, Perrotta A, Aloisio V, Voza A, Finizia L, Alaia A, Del Viscovo L

机构信息

Interventional US Service, D. Cotugno Hospital, Naples, Italy.

出版信息

Eur J Ultrasound. 1998 Dec;8(3):201-6. doi: 10.1016/s0929-8266(98)00077-9.

DOI:10.1016/s0929-8266(98)00077-9

PMID:9971904

Abstract

OBJECTIVE

percutaneous ethanol injection (PEI) under general anesthesia (One Shot PEI) is a new therapy for large and multiple hepatocellular carcinoma (HCC) by the injection of large amount of ethanol in the tumor. We report our results with 3 years survival rates in patients with HCC on cirrhosis treated with One Shot PEI.

PATIENTS AND METHODS

between October 1992 and July 1996, 112 cirrhotic patients (79 males; age: 45-80; mean: 64 years) with 215 HCC nodules (diameter 0.6-14 cm; mean 4.1 cm) underwent One Shot PEI. Fifty-three patients had a single nodule (diameter=3-14 cm; mean=4. 5 cm), 59 had two or more (two to five) nodules (diameter=0.6-13 cm; mean=4.9). Ethanol injected ranged between 16 and 120 ml per session. Survival rates were calculated according to Kaplan-Meier method and Wilcoxon test was used for statistical analysis.

RESULTS

five patients died within 7 h-10 days after the treatment for rupture of esophageal varices in three cases, rupture of subcapsular HCC in one case and liver failure in one case. In the remaining 107 patients, dynamic CT or spiral CT, performed 72 h-1 month after the treatment, showed complete necrosis in 76 cases (71%) and incomplete necrosis (although always ?50%) in 31. Survival rates at 1, 2, 3 years in all 107 patients were 88, 76, and 76% respectively. Survival rates in Child A Class patients were 100, 92, 92% and in Class B patients were 84, 72, and 72% at 1, 2, 3 years respectively; in Class C were 70 and 40% at 1 and 2 years respectively (P=0.01). Survival rates in patients with single nodule were 95, 82 and 82% at 1, 2 and 3 years, while in patients with multiple nodules were 80, 68 and 58% at 1, 2 and 3 years respectively (P=n.s.). During the follow-up (6-46 months) 48 patients showed intrahepatic recurrences; 41 out of them were retreated with new sessions of One Shot PEI or traditional PEI.

CONCLUSIONS

PEI One Shot is more aggressive than traditional PEI. Survival rates of PEI One Shot seems similar to those obtainable by conventional PEI and even better than surgery.

摘要

目的

全身麻醉下经皮乙醇注射（一次性经皮乙醇注射）是一种通过向肿瘤内注射大量乙醇来治疗大的和多发性肝细胞癌（HCC）的新疗法。我们报告了接受一次性经皮乙醇注射治疗的肝硬化合并HCC患者的3年生存率结果。

患者与方法

1992年10月至1996年7月，112例肝硬化患者（男性79例；年龄45 - 80岁；平均64岁），共215个HCC结节（直径0.6 - 14 cm；平均4.1 cm）接受了一次性经皮乙醇注射。53例患者有单个结节（直径3 - 14 cm；平均4.5 cm），59例有两个或更多（2至5个）结节（直径0.6 - 13 cm；平均4.9 cm）。每次注射乙醇量为16至120 ml。生存率根据Kaplan - Meier方法计算，采用Wilcoxon检验进行统计学分析。

结果

5例患者在治疗后7小时至10天内死亡，其中3例因食管静脉曲张破裂，1例因肝包膜下HCC破裂，1例因肝功能衰竭。其余107例患者在治疗后72小时至1个月进行的动态CT或螺旋CT检查显示，76例（71%）完全坏死，31例不完全坏死（尽管总是≥50%）。107例患者1年、2年、3年生存率分别为88%、76%和76%。Child A级患者1年、2年、3年生存率分别为100%、92%和92%；B级患者分别为84%、72%和72%；C级患者1年和2年生存率分别为70%和40%（P = 0.01）。单个结节患者1年、2年、3年生存率分别为95%、82%和82%，而多个结节患者分别为80%、68%和58%（P = 无显著差异）。在随访期间（6 - 46个月），48例患者出现肝内复发；其中41例接受了新一轮的一次性经皮乙醇注射或传统经皮乙醇注射治疗。