摘要
目的评价进展期胃底贲门癌行腹主动脉、腹腔动脉、胃左动脉(LGA)及左膈下动脉(LIPA)造影的意义;探讨LGA and LIPA联合化疗栓塞对进展期胃底贲门癌的价值。方法18例经DSA确认有LGA and LIPA均参与胃底贲门癌供血者行二动脉化疗栓塞术,LGA共行70次TACE,LIPA共行65次TACE。术前除胃镜和钡餐检查外均行多层螺旋CT三期增强扫描,术中常规行腹主动脉、腹腔动脉及LGA and LIPA造影,准确估计腔内外病变情况,在确认供血范围后将导管逐一超选择至LGA and LIPA支,再分别用碘油-抗癌乳剂栓塞肿瘤末梢血管,然后注入明胶海。结果LGA and LIPA联合化疗栓塞后1、2年、3年生存率分别为88.9%(16/18)、55.6%(10/18)、38.9%(7/18);有4例均行LGA and LIPA化疗栓塞2-3次后行外科手术根治术,已存活4年和5年,目前仍在随访中。未出现一例严重并发症。结论进展期胃底贲门癌术中行腹主动脉、腹腔动脉及LGA and LIPA造影能进一步明确肿瘤的T分期;行LGA and LIPA联合化疗栓塞是一种疗效好、安全性高、科学合理、并发症少且多为自限性的治疗方法。
Objiective To evaluate the abdominal aortic, celiac arterial and left gastric arterial （LGA） and left inferior phrenic arterial （LIPA） angiography of advanced cancer of the cardia and stomach fundus; to investigate the effects of LGA and LIPA combined with chemoembolization for advanced cancer of the cardia and stomach fundus. Methods： Eighteen cases of embolization were operated, proving by DSA that both LGA and LIPA involve in blood supply for cancer tumors of the cardia and stomach fundus, seventy times of TACE were performed on LGA and 65 times of TACE were performed on LIPA. Preoperatively, except of gastroscopy and barium meal examination, dynamic enhanced MSCT tri-phase scan was performed. Abdominal aortic, celiac arterial and LGA and LIPA angiography were routinely performed during operation in order to accurately estimate lesions inand outside abdominal cavity. After confirmation of the blood supply range, catheters were super-selected one by one to LGA and LIPA, peripheral tumor blood vessels were respectively embolized by Lipiodol and Adriamycin, and then filled by gelfoam sponges. Results： After LGA and LIPA embolization combined with chemotherapy, the survival rates of a year, 2 years and 3 years are 88.9% （16/18）, 55.6% （10/18） and 38.9% （7/18） respectively; 4 cases that have survived for 4 years and 5 years were performed three times with LGA and LIPA embolization combined with chemotherapy, successively operated with surgical resection. The two patients are currently in the follow-up study and no serious complication has occurred. Conclusions： the T-staging of tumors could be further established by performing abdominal aortic, celiac arterial and LGA and LIPA angiography for advanced cancer of the cardia and stomach fundus; the LGA and LIPA embolization combined with chemotherapy is an effective, highly safe and scientifically rational treatment, mostly self-limiting and with few complications occurred.
出处
《当代医学》
2009年第23期421-423,共3页
Contemporary Medicine
关键词
进展期胃底贲门癌
胃左/左膈下动脉
化疗栓塞治疗
Advanced Cancer of Cardia and Stomach Fundus
Left Gastric Artery and Left Inferior Phrenic Artery
Embolization combined with Chemotherapy.
