Long-term Follow-up Results of 70 Liver Cancer Cases Received Ultrasound Guided Percutaneous PDT

目的　分析光动力治疗肝癌的临床表现和远期疗效 ,探讨疗效影响因素和治疗适应证 ,为临床推广应用提供参考数据。方法　肝癌患者 70例 ,其中小肝癌 2例 ,大肝癌 6 8例。均经B超、CT定位 ,甲胎蛋白 (AFP)定量 ,病理组织学确诊。治疗前 48h ,患者行血卟啉衍生物 (HpD)皮试 ,阴性者按每公斤体重 5mg静脉给药。治疗时 ,在B超引导下 ,用 18G肝穿针经皮穿刺将石英光纤引导入肝肿瘤内进行光辐照。激光器为氩离子激光泵浦染料激光器系统 ,激光波长 6 30nm ,光纤末端为 1cm长柱状弥散头 ,输出功率 30 0～ 35 0mW ,每一照射点能量累积约 2 2 0J,肿瘤内实行多点照射。治疗后 1周 ,检查血常规、肝功能、AFP及B超 ,一个月后 ,行肝穿活检。多次治疗间歇时间为 1个月。结果　 70例肝癌行 170次治疗 ,其中接受 1次治疗 30例 ,多次治疗 40例。 1次治疗组 1年生存率 10 % ,无生存 2年者 ;2次治疗组 1年生存率 5 0 % ,2年以上生存率 8% ;3次以上治疗组 1年生存率 82 % ,2年生存率 5 0 % ,3年生存率 32 % ,其中 3例存活5年以上。全组只有 18%的患者出现治疗后短期内一过性ALT、AST轻度升高 (<5 0U)和TBIL轻度升高 ,余未见明显异常。随访患者 1～ 5年 ,未见肝功能远期受损。病人接受治疗后 ,只有 17%出现低热 3～ 4天 ,30 %的Objective To investigate the long-term follow-up results of ultrasound-guided percutaneous PDT for liver cancer and to evaluate the efficacy and safety of this technique. Methods 70 patients with liver cancers, including 2 small tumors and 68 large tumors, were examined by ultrasound, CT, AFP assay, and diagnosed by histopatholopy of needle biopsy. The patients received injection of hematoporphyrin derivative(HPD) i.v. in a dose of 5 mg/kg body weight 48 h prior to laser irradiation. An argon laser pumped dye laser system was used to give a CW laser beam at 630 nm. The light beam was split and coupled into three optical fibers. An ultrasound-guided percutaneous liver puncture was performed and optical fibers were inserted into the tumors via 18G needles. Efforts were made to ensure that irradiation points were distributed in entire tumor volume and a light output of 300～350 mW for 12 minutes per point was used. The patients were examined with routine blood test, liver functions, AFP assay and USG at one week after treatment. A month later they were reexamined by needle biopsy and received next PDT treatment. Results Total 170 treatments were performed in the 70 patients. Among them 30 cases were treated for only once, 12 cases twice, 12 cases 3 times, and 16 cases 4 times or more. All 70 cases were followed up for 1-5 years. The results showed that multiple treatment is more effective than single treatment. The 1-, 2-and 3-years survival rate was 10%, 0, 0 in the group by single treatment, respectively, 50%, 8% and 8% in the group treated twice, and 82%, 50% and 30% in the group treated by 3 or more time, respectively. Three patients from the last group have already been surviving for longer than 5 years. Slight increase of ALT, AST and total bilirubin occurred in only 18%, and mild fever occurred in 17% of the 70 cases for 3-4 days shortly after PDT treatment. No severe complications due to PDT such as severe hemorrhage after liver puncture, hepatic failure, biliary peritonitis or long-lasting liver dysfunctions were observed in our group. Conclusions Photodynamic therapy is effective and safe for the treatment of liver cancers including those following hepatic resection or those failed after embolic chemotherapy by hepatic artery infusion. However, we would suggest that single PDT treatment is not enough and repeated PDT treatments are recommended in order to obtain a significant therapeutic effect to patients with large liver cancers.福建省“95”重点科技项

Ultrasound Guided Percutaneous PDT For Advanced Liver Cancer A Report of 30 Cases

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