肝动脉化疗栓塞与肝脾动脉双栓塞治疗肝癌伴肝硬化的比较

目的比较肝动脉化疗栓塞(A组)和肝脾动脉双栓塞(B组)治疗肝癌并肝硬化病人的反应率、生存率、并发症和毒副作用。方法确诊为肝癌并肝硬化的63例病人随机分组，A组31例，B组32例。A组行肝动脉化疗栓塞，B组行肝动脉化疗栓塞加部分脾动脉栓塞。结果A和B组有效率分别为64.5%(20/31)和65.6%(21/32)，腹水吸收好转率分别为33.3%(4/12)和69.2%(9/13)。A组6个月、1、2、3年的累计生存率分别是80.5%(25/31)；41.9%(13/31)，19.4%(6/31)，6.5%(2/31)，B组6个，1、2、3年累计生存率分别是75.0%(24/32)，56.2%(18/32)，34.4%(11/32)，25.0%(8/32)，B组术后并发2例脾脓肿和3例胸积液，并发消化道出血明显减少。结论肝脾动脉双栓塞治疗肝癌并肝硬化能够提高病人对抗癌药的耐受性，提高远期生存率和降低上消化道出血的危险性。

Comparison oftranscatheter hepatic arterial chemoembolization versus hepatic and splenic arterialdouble embolization in the treatment of hepatoma complicated with cirrhosis.

Objective　To compare the effects of transcatheter hepatic arterial chemoembolization (A arm) with hepatic and splenic arterial do uble embolization(B arm) on hepatoma complicated with cirrhosis.Methods 　63 patients were involved in this study.31 cases underwent transcathet er hepatic arterial chemoembolizations (TACE) as group A.The remaining 32 cases additio nally plused transcatheter partial splenic arterial embolizations (PSE) as group B.Results　An objective response rate was observed in 64.5%(20/31) of patients in group A versus 65.6%(21/32) in group B.Postoperatively 33.3%(4/12)a nd 69.2%(9/13) patients with ascites completely absorbed in group A and group B respectively.The cumulative survival rate of 6 months、1、2、3-yars was 80.5%(2 5/31)、41.9%(13/31)、19.4%(6/31) and 6.5%(2/31) in group A respectively and 75.0 %(24/32),56.2%(18/32),34.4%(11/32) and 25.0%(8/32) in group B respectively.Pleur al effusions were found in 3 patients and spleen abscess in 2 patietns and upper gastrointestinal bleeding in a few patients after double embolization.C onclusions　The combined onestep TACE/PSE treatment can improve patient' s tolerance to antiblastic drugs,reduce hemorrhagic complication and enhance pat ient's survival rate.