【摘要】 目的 探讨中晚期宫颈癌术前动脉灌注化疗栓塞的临床价值。 方法 选择2005年6月-2009年12月35例经阴道镜活检确诊为宫颈癌临床分期Ⅱa~Ⅲb期宫颈癌患者，术前行1次子宫动脉化疗栓塞，化疗药物为博莱霉素（BLM）+顺铂（DDP）+环磷酰胺（CTX），栓塞剂为超液化碘油加明胶海绵颗粒。介入治疗后14~20 d行子宫全切加淋巴结清扫术。观察动脉灌注化疗栓塞前后肿块的大小变化、术中肿块粘连状况及出血量的多少。 结果 经介入治疗后肿块缩小32例：完全缓解（CR）3例、部分缓解（PR）29例，肿块无变化（NC）2例，进展（PD）1例，治疗有效率为91.4%。31例选择了手术治疗，手术率为88.6%。术中肿块粘连状况：无粘连24例，轻度粘连6例，中度粘连1例。术中出血量：≤100 mL 7例，100~200 mL 18例，200~400 mL 6例。 结论 中晚期宫颈癌术前动脉灌注化疗栓塞能有效地提高肿瘤切除率，降低手术风险。【Abstract】 Objective To evaluate the clinical value of preoperative transarterial chemoembolization for advanced cervical cancer. Methods A total of 35 patients with pathologically proved cervical cancer (from stage Ⅱa to Ⅲb) from June 2005 to December 2009 received preoperative transarterial chemoembolization once. Bleomycin, cisplantin and cytoxan were infused via bilateral uterine arteries, followed by arterial emboliezation with super-liquefaction iodipin and gel foam particles as embolic agent. Radical surgery was performed on the patients after 14-20 days. Volume change of mass, accretion state and haemorrhagia amount during the operation were analyzed. Results The masses deflated in 32 cases: complete response (CR) in 3, and partial response (PR) in 29. No change (NC) was seen in 3 cases. The effective rate was 91.4%. In 31 cases who underwent the operation, the operability was 88.6%, in whom non-accretionin was in 24, light accretion was in 6 and medium accretion was in 1. Haemorrhagia amount was less than 100 mL in 11 cases, 100-200 mL in 21cases, and 200-1 400 mL in 3 cases. Conclusion Preoperative chemoembolization can elevate exairesis rate and depress the operative risk effectively.
ObjectiveTo summarize the research progress on the pathogenesis of ischemic bile duct injury after transcatheter arterial chemoembolization (TACE).MethodThe recent studies on the incidence, pathological features and related mechanisms of ischemic bile duct injury and ischemic bile duct injury after TACE were reviewed.ResultsThe incidence of ischemic bile duct injury after liver TACE fluctuated greatly and was related to different chemoembolization methods. At present, the causes of ischemic bile duct injury were attributed to the bile duct ischemia caused by embolization and the toxic effects of chemotherapeutic drugs. The destruction of protective mechanism of bile duct epithelium and the expression of transforming growth factor-β might play an important role in ischemic bile duct injury.ConclusionsAfter liver TACE, in addition to the direct injury of bile duct caused by the toxic effects of ischemia and chemotherapy drugs, the damage of bile duct epithelial protection mechanism caused by ischemia and chemotherapy drugs makes the toxic effects of bile acids play a very important role in the ischemic bile duct injury. However, there is still no direct evidence of bile duct epithelial protection mechanism in ischemic bile duct injury after liver TACE. Further clarifying the role of bile duct epithelial protection mechanism in ischemic bile duct injury after liver TACE will be helpful to explore its prevention and treatment measures, and provide new insights for the further studies in future.