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目的:探讨肝动脉造影和肝动脉栓塞术在防治肝癌切除术后残癌的应用价值。方法:在原发性肝癌切除术后的2mo,对69例原发性肝癌切除术后患者(其中根治性性手术51例、姑息性手术18例)进行肝动脉造影和肝动脉栓塞化疗,比较了肝动脉造影和B超在诊断术后残癌的敏感性,观察了肝动脉栓塞化疗治疗残癌的临床效果。结果:69例原发性肝癌切除术后患者中发现残癌26例,其中姑息性手术者残癌的发生率为100％(18/18),根治性手术者15.7％(8/51)。残癌的平均直径为2..71±2.16cm,直径≤1cm占23.1％(6/26),≤2cm为65.4％(17/26),但多为多发性,占69.2％(18/26)。比较同期的B超和肝动脉造影发现残癌的敏感性,B超阳性者占38.5％(10/26),肝动脉造影阳性者占92.0％(23/25),肝动脉造影敏感性高于B超(p<0.005)。26例残癌经肝动脉栓塞化疗,其1a,2a生存率分别为90.0％和78.0％。结论:肝动脉造影能够早期发现术后残癌,原发性肝癌切除术后有残癌倾向者,特别是姑息性手术者应进行肝动脉栓塞化疗。
Objective: To investigate the value of hepatic artery angiography and hepatic artery embolization in preventing and treating residual cancer after hepatectomy. METHODS: Hepatic artery angiography and hepatic artery embolization chemotherapy were performed on 69 cases of hepatocellular carcinoma resection (including radical surgery in 51 cases and palliative operation in 18 cases) 2 months after resection of primary hepatocellular carcinoma. The sensitivity of hepatic artery angiography and B-ultrasonography in the diagnosis of residual cancer was observed. The clinical effect of hepatic artery embolization chemotherapy for residual cancer was observed. RESULTS: Twenty-six cases of residual cancer were found in 69 patients with hepatocellular carcinoma after resection. The incidence of residual cancer was 100% (18/18) in palliative surgery and 15.7% (8/51) in radical surgery. The average diameter of residual cancer was 2..71±2.16cm, 23.1% (6/26) in diameter ≤1cm, and 65.4% (17/26) in ≤2cm, but mostly multiple, accounting for 69.2% (18/26). ). The sensitivity of residual ultrasound detected by ultrasound and hepatic arteriography in the same period was 38.5% (10/26) in B-positive patients, and 92.0% (23/25) in those with positive hepatic arteriography. The sensitivity of hepatic arteriography was higher than that of B-ultrasound. B ultrasound (p<0.005). Among 26 patients with residual cancer treated by transcatheter arterial chemoembolization, their 1a and 2a survival rates were 90.0% and 78.0%, respectively. Conclusion: Hepatic artery angiography can detect early postoperative residual cancer. There is a tendency of residual cancer after resection of primary hepatic cancer. In particular, palliative operation should be treated with hepatic artery embolization.