经肝动脉化疗栓塞联合肿瘤间质治疗肝癌的疗效及其病理变化

目的观察经肝动脉化疗栓塞联合肿瘤间质治疗肝癌的疗效及病理变化。方法将2007年1月至2011年6月我院收治的38例中晚期肝癌患者随机分为对照组和观察组,每组19例,均无肾功能异常及凝血功能障碍。对照组予以单纯经肝动脉化疗栓塞治疗,观察组予以肝动脉化疗栓塞联合肿瘤间质治疗。观察治疗后病灶内的碘油沉积率和病理变化,治疗1周后患者肝功能的变化,治疗6个月后肿瘤的局控率、病灶缩小率,并随访2年,观察患者的生存情况。结果对照组肿瘤细胞坏死以凝固性坏死为主,而观察组肿瘤细胞以脂肪样变性为主;观察组患者病灶碘油沉积率、治疗6个月后的肿瘤缩小率和局部控制率分别为(86.3±8.8)%,(32.3±9.7)%,78.95%,均显著高于对照组(56.4±23.2)%,(27.3±11.5)%,52.63%;观察组治疗1周后谷丙转氨酶、谷草转氨酶和总胆红素水平均显著高于对照组,但其白蛋白水平明显低于对照组;观察组1年和2年的生存率分别为94.74%,73.68%,与对照组的78.95%,47.37%相比均显著升高。结论经肝动脉化疗栓塞联合肿瘤间质治疗与单用肝动脉化疗栓塞治疗肝癌相比,碘油在病灶的沉积率高,且临床疗效更好。

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Objective To observe the therapeutic effects and pathological changes of liver cancer treated by transcatheter arterial chemoebolization combined with interstitial therapy.Methods 38 patients with middle/late stage liver cancer admitted in our hospital from January 2007 to June 2011 were randomly divided into control group and observation group,19 patients in each group.All patients had no abnormal renal function and no coagulation disorders.Patients in the control group were treated only by transcatheter arterial chemoebolization,while patients in the observation group were treated by transcatheter arterial chemoebolization plus interstitial therapy.We observed the rate of lipiodol deposition and pathological changes after treatment,the changes of liver function one week after treatment,tumour regression rates and local tumor control rates of six months after treatment,as well as 1-year and 2-year survival rates.Results In control group observed mainly were a great quantity of coagulation necrosis of tumor focus,while in observation group mainly were lipoid degeneration necrosis.The rate of lipiodol deposition in focus,tumour regression rates and local tumor control rates of 6 months after treatment in the observation group were respectively 86.3±8.8%,32.3±9.7% and 78.95% respectively,which were all significantly higher than that of the control group(respectively 56.4±23.2%,27.3±11.5%,52.63%).The level of glutamic pyruvic transaminase(GPT),glutamic oxalacetic transaminase(GOT) as well as total bilirubin(TB) were also all significantly higher in observation group than those in control group,but the level of albumn was lower in observation group than that in control group.In addition,the 1-year and 2-year survival rate in the observation group were respectively 94.74% and 73.68%,which were both markedly higher than those in the control group(78.95%,47.37%).Conclusions The rate of lipiodol deposition in focus of liver cancer treated by transcatheter arterial chemoebolization combined with interstitial therapy was improved in comparison with treatment with single transcatheter arterial chemoebolization,and the therapeutic effects were much better as well.