经动脉导管介入治疗中晚期肝癌患者的近期疗效分析

目的 观察中晚期肝癌患者经动脉导管介入治疗的近期疗效。 方法 选择2011年10月—2013年10月宁波市第二医院收治的53例原发性中晚期肝癌患者为研究对象,根据肿瘤大小分为小肝癌组(直径≤5 cm)和大肝癌组(直径>5 cm)。所有患者均给予经动脉导管介入治疗,选择经皮股动脉穿刺,超声引导下将插管插到肝固有动脉或肝左右动脉,注入顺铂+丝裂霉素+5-氟尿嘧啶,间隔1个月再行灌注,方法同前,以此重复3~4次。评估介入前后症状改善情况、疗效评价、卡氏评分及生存率。 结果 治疗后,53例中晚期肝癌中,食欲改善者30例,腹痛减轻者28例,体重增加者23例,且小肝癌组以上人数多于大肝癌组(P<0.05);AFP降低者共23例,其中小肝癌组AFP降低者比例高于大肝癌组(P<0.05);治疗后,53例中晚期肝癌中,CR+PR为36例,达67.9%,其中小肝癌组有效率(83.3%)高于大肝癌组有效率(55.2%),P<0.05;与治疗前相比,53例患者ALT、AST均较治疗前提高(P<0.05),治疗后,大肝癌组ALT、AST、TBIL均高于小肝癌组(P<0.05);53例患者1、2、3年生存率分别为60.4%、47.2%、24.5%,小肝癌组1、2年生存率高于大肝癌组(P<0.05),2组3年生存率差异无统计学意义,小肝癌组治疗后卡氏评分高于大肝癌组(P<0.05)。 结论 经动脉导管介入治疗中晚期肝癌可有效改善患者近期疗效,提高患者半年生存率,且其对近期疗效的影响与肿瘤大小有关。 

Short term efficacy of transcatheter arterial chemoembolization of patients with mid-late stage liver cancer

Objective To observe the short-term efficacy of transcatheter arterial chemoembolization (TACE) in the treatment of mid-late stage hepatocellular carcinoma (HCC). Methods Total 53 patients with mid-late stage primary liver carcinoma in the Second Hospital of Ningbo from October, 2011 to October, 2013 were selected as the research objects, according to the tumor size, they were assigned into small HCC group (less than 5 cm) and large HCC group (diameter > 5cm). All patients were treated with transcatheter arterial chemoembolization by percutaneous femoral artery puncture, the intubation inserted into the hepatic artery or right hepatic artery injection, cisplatin + fluorouracil and mitomycin + 5-FU, interval of one month before reperfusion, repeated 3-4 times. The improvement of symptoms and the effect of treatment before and after the intervention were evaluated. Results After the treatment, the appetite was improved in 30 cases, abdominal pain improved in 28 cases, weight gain in 23 cases, especially in the small HCC group, there was significant difference between the two groups (P < 0. 05); AFP decreased in 23 cases, most in small HCC group AFP (P < 0. 05); after the treatment, among 53 patients, there were 36 cases of CR + PR (67. 9%), especially in the small HCC group (83. 3%, P < 0. 05); When compared with that before the treatment, ALT and AST in 53 patients were significantly improved (P < 0. 05), the levels of ALT, AST and TBIL in large HCC group were higher than those of small HCC group (P <0. 05); Among the 53 patients, the 1-, 2-and 3-year survival rates were 60. 4%, 47. 2% and 24. 5%, respectively, the 1-and 2-year survival rates in the small HCC group was higher than that of large HCC group (P < 0. 05), however, there was no significant difference in the 3-year survival rate between the two groups (P > 0. 05). Karnofsky score in the small HCC group was higher than that of large HCC group (P < 0. 05). Conclusion The transcatheter arterial chemoembolization in the treatment of mid-late stage liver cancer can effectively improve the short-term efficacy, and the outcome is related with tumor size.