目的 探讨经导管动脉化疗性栓塞(TACE)结合Ⅱ期手术切除治疗巨块型外生型肝细胞癌(E-HCC)的可行性.方法 对5例E-HCC患者,先行TACE.术后1个月复查,CT显示病灶内碘油沉积欠佳者再行动脉造影和TACE术.待肿瘤缩小而不能经动脉途径有效给药时,行Ⅱ期手术切除.结果 5例患者行TACE共9次,平均1.8次.全部病例于TACE后1个月行CT检查,碘油在瘤体沉积表现为3型:完全填充型1例、致密型3例、斑片或环状型1例.5例患者均行Ⅱ期手术切除,3例成功行根治切除,2例因周边组织受侵、粘连严重而行姑息性切除.术后病理显示肿瘤有35%～100%(平均74.8%)的坏死.随访13～27月,1例存活,4例死亡,平均生存期为22.2月.无严重手术并发症发生.结论 TACE可使E-HCC坏死、缩小,提高Ⅱ期手术切除的机会.%Objective To investigate the efficacy and safety of transcatheter arterial chemoembolization (TACE) in combination with secondary resection in the treatment of massive extrahepatic growing hepatocellular carcinoma (E-HCC). Methods Five patients were involved in this study. CT reviewed after the first time of TACE treatment a month. If the lesion was not filled with satisfaction by chemotherapic agents lipiodol emulsion, arterial angiography and TACE were performed again. If failed to inject chemotherapic agents lipiodol emulsion into the lesions through the feeding arteries, the secondary resection was used. Results Five patients underwent TACE treatment 9 times, an average of 1.8 times. CT reviewed the iodized oil deposition in the tumor showed 3 types after all patient were treated first time of TACE a month: completely filled 1 case; dense filled 3 cases; spot or ring-type filled 1 case. After received the secondary resection, 3 cases of them were underwent curative resection successfully, the other 2 cases were used palliative resection due to surrounding tissue severe adhesion. Post-operative pathological specimen showed 35%～100% tumor necrosis (average 74.8%). During a follow-up of 13～27 months, 1 survived and 4 deaths, the median survival time was 22.2 months. No severe complications were observed. Conclusion TACE can induce obvious necrosis and shrinkage of E-HCC and increase the opportunities of secondary resection.
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