125I粒子植入联合肝动脉栓塞化疗治疗肝癌

目的 探讨125I粒子植入联合经肝动脉栓塞化疗治疗肝癌的短期疗效和安全性.方法 60例经病理检查确诊的肝癌患者,按照入院时间的单、双日,随机分为观察组和对照组,观察组28例,对照组32例.观察组患者确诊后行肝动脉栓塞化疗,2周后用放射性粒子计算机治疗计划系统制定治疗方案,在CT或B超导向下经皮穿刺,将125I粒子植入肝脏瘤体内,平均植入粒子数25粒/例(15-4JD粒/例).粒子植入术后定期行肝动脉栓塞化疗.粒子植入治疗前、后进行血常规、肝功能等检测,并进行重复测量方差分析.每2个月复查1次X线平片及腹部CT.对照组患者行单纯经肝动脉栓塞化疗.2组患者一般临床资料及生存率、有效率的比较采用X2检验.结果 观察组28例放射性粒子按术前计划植入到位,植入过程中无粒子丢失及移位;粒子植入后1周内丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)有一过性升高,2周后基本恢复正常;WBC、Hb、IgA、IgG手术前后无明显变化;术后未见严重并发症发生.治疗后4个月观察组有效率为75.0%(21/28),对照组为37.5%(12/32),2组差异有统计学意义(X2=8.485,P=0.004).观察组和对照组6个月生存率分别为92.9%(26/28)和75.0%(24/32),2组差异无统计学意义(X2=2.263,P=0.132);1年生存率分别为72.0%(18/25)和43.3%(13/30),2组间差别有统计学意义(X2=4.556,P=0.033).结论 125I粒子植入联合肝动脉栓塞化疗治疗肝癌方法简单易行、安全、近期疗效确切.

Treatment of hepatic carcinoma using iodine-125 seeds in conjunction with the transcathether arterial chemoembolization

Objective To investigate the short-term efficacy and security of combined treatment of iodine-125 seeds and transeathether arterial chemoembolization in liver neoplasms. Methods Transcathether arterial chemoembolization underwent in experimental group (28 cases) with liver neoplasm. The treatment plan was formulated with treatment planning system and a median of 25 seeds per patient (range, 15--40 seeds) were implanted under CT or B ultrasound guidance in 2 weeks after the procedure. Transcathether arterial ehemoembolizafion underwent after the implanted regularity. Blood routine and liver function were detected before and after the procedure. X ray check and abdomen CT scan were performed each 2 months. Control group (32 cases) were treated with transcathether arterial chemoembolization alone. Analysis of variance and Chi-square test were used for statistics. Results All seeds were released to the target places successfully and no seed was found to be lost or migrated in experimental group. Transient elevation of the serum ALT and AST but recovered in 2 week. WBC, Hb, IgA and IgG were showed no significant changes. The severe complication was not found in those eases. The responsive rate of tumor was 75.0% (21/28), 37.5% (12/32) in experimental group and control group, respectively(X2 = 8.485,P = 0.004). The survival rate of 6 months was 92.9% (26/28), 75.0% (24/32) in experimental group and control group, respectively(X2=2.263,P=0.132). The surviral rate of 12 months was 72.0% (18/25), 43.3% (13/30) in experimental group and control group, respectively (X2 = 4.556, P=0.033). Conclusion It is simple, feasible, safe and short-termly effective for liver neoplasms in treatment combined iodine-125 seeds implantation with transcathether arterial chemoembolization.