经导管动脉化疗栓塞治疗肝细胞癌的疗效观察

目的研究经导管动脉化疗栓塞（TACE）治疗肝细胞癌（HCC）的疗效及对HCC预后的影响。方法经手术病理证实的HCC患者139例,其中TACE组81例,单纯手术组58例。用末端脱氧核苷转移酶介导的d—UTP毛地黄毒素缺口末端标记（TUNEL）法检测凋亡细胞,用免疫组化检测各标本bcl-2、bax、p53、增殖细胞核抗原（PCNA）和Ki-67蛋白表达,分析两组的肿瘤标志物改变、肿瘤坏死、包膜形成、体积、复发转移率及累计生存率。结果TACE可使肿瘤包膜形成、体积缩小,引起肿瘤坏死,诱导细胞凋亡,导致增殖转移潜能下降。TACE组患者的中位生存期为803．3d,1,2,3年生存率分别为84．0％、67．9％和40．7％;单纯手术组患者的中位生存期为742．5d,1,2,3年生存率分别为72．4％、55．2％和24．1％（P〈0．05）。结论TACE治疗HCC安全有效,可改善患者的生存率。

Transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma

Objective To evaluate the effect of transcatheter arterial chemoembolization (TACE) on the result and the prognosis of hepatocellular carcinoma(HCC) at systemic, cellular, genetic and molecular levels. Methods Patients with histologically proven HCC were divided into two groups: 81 patients in Group A undergoing TACE before operation and 58 patients in Group B treated with surgical resection alone. The degree of apoptosis was analyzed by transferase -mediated dUTP nick end labeling (TUNEL) stain. The expressions of bcl-2, bax,p53,Ki-67 and PCNA proteins were detected by immunohistochemical method. The changes of these markers, tumor necrosis, encapsulation, volume, metastasis, recurrence and cumulative survival in each group were retrospectively analyzed. Results The more tumor necrosis, apoptosis, encapsulation and tumor shrinkage observed, and the less recurrence resulted from TACE in group A than in group B. The cumulative 1-, 2-,and 3-year survival rates and median survival time were 84.0%, 67.9%, 40.7%, and 803.3 days in group A patients; they were 72.4%, 55.2%, 24.1%, and 742.5 days in group B patients(P<0.05). ConclusionPreoperative transcatheter arterial chemoembolization is safe and effective as an auxiliary preparatory means before surgical treatment of hepatocellular carcinoma as it may improve the survival of HCC patients.