肝癌介入治疗进一步思考
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摘要
肝细胞肝癌是全球最常见的恶性肿瘤之一,发生率与死亡率均居前列。目前肝癌介入治疗在我国逐步得到推广及发展,取得了很大成就,但有些方面需要进一步思考。肝癌可视为一种慢性疾病,以介入为主综合治疗中晚期肝癌比较合理的目标是控制肿瘤生长,延长有质量的生存期。但实现这一目标并非易事,需要不断更新观念,随时调整治疗策略。制定肝癌治疗方案时,必须考虑肿瘤治疗与维持正常机体功能的平衡,同时兼顾规范化与个体化治疗。肝癌生物学特性决定了肝癌治疗是长期、多学科、多方法的综合治疗。重视肝癌治疗的社会适应证、效价比及肝功能储备,对合理安排治疗时间和间期颇为重要。应在合理选择精细TACE和适度TACE基础上,理性对待新型栓塞材料。
Hepatocellular carcinoma(HCC) is one of the most common malignant tumors in the world, its incidence and mortality are at the forefront of the list. The interventional therapy of liver cancer has been gradually popularized and developed in China, and great progress has been achieved. However, in clinical practice there are certain aspects that require further consideration. Liver cancer can be regarded as a chronic disease, and the reasonable goal of comprehensive therapy dominated by intervention for advanced liver cancer is to control the tumor growth and to prolong a good quality life span. But achieving this goal is not a easy thing, it needs to keep updating ideas and to adjust treatment strategy at all times. When making a plan for the treatment of liver cancer, it is necessary to pay attention to the balance between the treatment of tumor and the function of the body, and both standardization therapy and individualized therapy should be taken into consideration. Biological characteristics of HCC determine that the treatment of HCC requires long-term, multidisciplinary and multi-method combination therapy. In treating liver cancers, attention should be paid to social indications, the efficiency-to-price ratio and liver function reservation, which is very important for reasonably arranging treatment time and interval. On the basis of reasonable selection of fine transcatheter arterial chemoembolization(TACE) and moderate TACE, the new embolic materials should be properly used.(J Intervent Radiol, 2019, 28: 507-510)
Hepatocellular carcinoma(HCC) is one of the most common malignant tumors in the world, its incidence and mortality are at the forefront of the list. The interventional therapy of liver cancer has been gradually popularized and developed in China, and great progress has been achieved. However, in clinical practice there are certain aspects that require further consideration. Liver cancer can be regarded as a chronic disease, and the reasonable goal of comprehensive therapy dominated by intervention for advanced liver cancer is to control the tumor growth and to prolong a good quality life span. But achieving this goal is not a easy thing, it needs to keep updating ideas and to adjust treatment strategy at all times. When making a plan for the treatment of liver cancer, it is necessary to pay attention to the balance between the treatment of tumor and the function of the body, and both standardization therapy and individualized therapy should be taken into consideration. Biological characteristics of HCC determine that the treatment of HCC requires long-term, multidisciplinary and multi-method combination therapy. In treating liver cancers, attention should be paid to social indications, the efficiency-to-price ratio and liver function reservation, which is very important for reasonably arranging treatment time and interval. On the basis of reasonable selection of fine transcatheter arterial chemoembolization(TACE) and moderate TACE, the new embolic materials should be properly used.(J Intervent Radiol, 2019, 28: 507-510)
引文
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[5]杨清慧,张雯,颜志平,等.植入放射性支架联合经动脉化疗栓塞(TACE)治疗肝恶性肿瘤合并下腔静脉(IVC)梗阻[J].复旦学报·医学版,2014,41:617-623.
[6]江旭,杨继金,李慧.碘-125粒子植入近程放疗在肝胆胰恶性肿瘤中的应用[J].临床肝胆病杂志,2016,32:2300-2304.
[7]王勇,刘会春,李宗狂,等.经皮胆道支架联合125I粒子腔内植入治疗恶性梗阻性黄疸的初步研究[J].中华放射学杂志,2014,48:403-407.
[8]陈敏山,陈敏华.肝癌局部消融治疗规范的专家共识[J].中华肝脏病杂志,2011,19:385-388.
[9]张子寒,罗剑钧,颜志平,等.血管内近程放疗联合支架植入及经动脉化疗栓塞治疗肝细胞肝癌合并门脉主干癌栓[J].复旦学报·医学版,2016,43:1-8.
[10]陆培新,王金兵,吴一迁,等.乙型肝炎病毒表面抗原携带者队列前瞻性研究在肝癌发生发展中的意义[J].中华医学杂志,2001,81:856-859.
[11]王建华,王小林,颜志平.腹部介入放射学[M].上海:复旦大学出版社,1998.
[12]汤钊猷.从生物学角度看肝癌治疗趋势[J].中华肝胆外科杂志,2009,15:401-402.
[13]杨敏捷,罗剑钧,刘清欣,等.125I粒子条剂量分布研究[J].介入放射学杂志,2015,24:59-63.
[14]李说,颜志平,张雯,等.兔门静脉主干内植入连续排列125I粒子条的实验研究[J].介入放射学杂志,2009,18:607-611.
[15]吴林霖,颜志平,张雯,等.经动脉灌注化疗联合125I粒子条治疗原发性肝癌合并门脉癌栓的疗效分析[J].介入放射学杂志,2015,24:776-780.
[16]罗剑钧,颜志平,王建华,等.腔内植入125I粒子条及支架联合经动脉化疗栓塞治疗原发性肝癌合并门脉主干癌栓的疗效[J].中华肿瘤杂志,2011,33:535-539.
[17]吴林霖,罗剑钧,颜志平,等.门脉支架及TACE联合或未联合血管内植入碘-125(125I)粒子条治疗肝癌合并门脉主干癌栓(MPVTT)的随机对照研究[J].复旦学报·医学版,2013,40:354-359.
[18]Wang WD,Hou S,Zhong ZL,et al.Radiofrequency ablation combined with transcatheter arterial chemoembolization therapy versus surgical resection for Barcelona-Clinic Liver Cancer(BCLC)A hepatocellular carcinoma:a meta-analysis[J].J Intervent Med,2018,1:49-57.
[19]司增梅,钱晟,刘嵘,等.微波消融同步联合TACE治疗大肝癌和巨块型肝癌的临床疗效分析[J].复旦学报·医学版,2016,43:563-568.
[20]李慕行,张谞丰,程继文,等.钇-90微球经动脉放疗栓塞治疗不可切除原发性肝癌疗效的Meta分析[J].中华肝脏外科手术学电子杂志,2014,3:26-30.
[21]沈海洋,刘瑞宝.钇90微球经肝动脉选择性放射治疗肝肿瘤应用现状[J].实用肿瘤学杂志,2009,23:582-585.
[22]杨积慧,颜志平,王建华,等.不同粒径ContourSe微球栓塞肝动脉治疗兔VX-2移植性肝癌的实验研究[J].中国临床医学,2009,16:83-86.
[2]林贵,顾瑨,韩莘野,等.选择性血管造影在诊断原发性肝癌上的作用[J].中华外科杂志,1982,20:71-73.
[3]林贵.肝动脉栓塞治疗原发性肝癌的初步报告[J].中华放射学杂志,1984,18:241-244.
[4]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范[J].中华消化外科杂志,2017,16:635-647.
[5]杨清慧,张雯,颜志平,等.植入放射性支架联合经动脉化疗栓塞(TACE)治疗肝恶性肿瘤合并下腔静脉(IVC)梗阻[J].复旦学报·医学版,2014,41:617-623.
[6]江旭,杨继金,李慧.碘-125粒子植入近程放疗在肝胆胰恶性肿瘤中的应用[J].临床肝胆病杂志,2016,32:2300-2304.
[7]王勇,刘会春,李宗狂,等.经皮胆道支架联合125I粒子腔内植入治疗恶性梗阻性黄疸的初步研究[J].中华放射学杂志,2014,48:403-407.
[8]陈敏山,陈敏华.肝癌局部消融治疗规范的专家共识[J].中华肝脏病杂志,2011,19:385-388.
[9]张子寒,罗剑钧,颜志平,等.血管内近程放疗联合支架植入及经动脉化疗栓塞治疗肝细胞肝癌合并门脉主干癌栓[J].复旦学报·医学版,2016,43:1-8.
[10]陆培新,王金兵,吴一迁,等.乙型肝炎病毒表面抗原携带者队列前瞻性研究在肝癌发生发展中的意义[J].中华医学杂志,2001,81:856-859.
[11]王建华,王小林,颜志平.腹部介入放射学[M].上海:复旦大学出版社,1998.
[12]汤钊猷.从生物学角度看肝癌治疗趋势[J].中华肝胆外科杂志,2009,15:401-402.
[13]杨敏捷,罗剑钧,刘清欣,等.125I粒子条剂量分布研究[J].介入放射学杂志,2015,24:59-63.
[14]李说,颜志平,张雯,等.兔门静脉主干内植入连续排列125I粒子条的实验研究[J].介入放射学杂志,2009,18:607-611.
[15]吴林霖,颜志平,张雯,等.经动脉灌注化疗联合125I粒子条治疗原发性肝癌合并门脉癌栓的疗效分析[J].介入放射学杂志,2015,24:776-780.
[16]罗剑钧,颜志平,王建华,等.腔内植入125I粒子条及支架联合经动脉化疗栓塞治疗原发性肝癌合并门脉主干癌栓的疗效[J].中华肿瘤杂志,2011,33:535-539.
[17]吴林霖,罗剑钧,颜志平,等.门脉支架及TACE联合或未联合血管内植入碘-125(125I)粒子条治疗肝癌合并门脉主干癌栓(MPVTT)的随机对照研究[J].复旦学报·医学版,2013,40:354-359.
[18]Wang WD,Hou S,Zhong ZL,et al.Radiofrequency ablation combined with transcatheter arterial chemoembolization therapy versus surgical resection for Barcelona-Clinic Liver Cancer(BCLC)A hepatocellular carcinoma:a meta-analysis[J].J Intervent Med,2018,1:49-57.
[19]司增梅,钱晟,刘嵘,等.微波消融同步联合TACE治疗大肝癌和巨块型肝癌的临床疗效分析[J].复旦学报·医学版,2016,43:563-568.
[20]李慕行,张谞丰,程继文,等.钇-90微球经动脉放疗栓塞治疗不可切除原发性肝癌疗效的Meta分析[J].中华肝脏外科手术学电子杂志,2014,3:26-30.
[21]沈海洋,刘瑞宝.钇90微球经肝动脉选择性放射治疗肝肿瘤应用现状[J].实用肿瘤学杂志,2009,23:582-585.
[22]杨积慧,颜志平,王建华,等.不同粒径ContourSe微球栓塞肝动脉治疗兔VX-2移植性肝癌的实验研究[J].中国临床医学,2009,16:83-86.
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