肝癌患者介入治疗后早期肝功能动态变化对预后的价值

目的研究肝动脉和肝段动脉栓塞治疗肝癌引起的肝功能变化及其临床意义。方法52例肝癌行常规栓塞化疗（常规组），33例行节段性栓塞化疗（节段组），两组肝癌患者分别采用肝动脉和肝段动脉两种不同的治疗方式，栓塞治疗后3d和6个月复查肝功能，对主要指标进行比较分析。所有病例随访1～5年。结果两组不同的栓塞化疗方式治疗后3d肝功能主要指标ALT、AST、ALP、TBIL的变化，常规组较节段组显著升高，两组相比差异有统计学意义（P=0．000）。栓塞后6个月肝功能Child分级下降程度节段组明显较常规组轻，差异有统计学意义（P=0．000）。节段组1、3、5年生存率分别为90．9％、60．6％和30．3％，常规组为61．5％、21．2％和7．7％，两组比较差异有统计学意义（P=0．003、P=0．000、P=0．006）。结论节段性栓塞化疗对肝癌病灶杀伤性强，对肝功能的损害小，远期疗效明显优于常规栓塞化疗。

Early dynamic changes of liver function and its prognostic implications after therapy of interventional radiology for hepatocenular carcinoma

Objective To study the changes of liver function and its clinical significance during the treatment of hepatocellular carcinoma by hepatic arterial and segmental arterial embolization. Methods Hepatic arterial embolization (conventional LP-TAE) was performed in 52 cases of hepatocellular carcinoma and segmental arterial embolizational(segmental LP-TAE) was done in 33 cases. The main data of the change of liver function were reviewed in three days and six months after treatment. All cases were followed up for 1 to 5 years. Results The change of ALT, AST, ALP, TBIL in conventional LP-TAE were remarkably increased than that in segmental LP-TAE after three days (P=0.000). After six months by LP-TAE, the Child of liver function in segmental group decreased obviously lighter than that in conventional group (P=0.000). The survival rates at 1-, 3-, and 5-year were 90.9%, 60.6% and 30.3% in segmental LP-TAE, respectively, and 61.5%, 21.2% and 7.7%, in conventional LP-TAE, respectively (P =0.003, P =0.000, P =0.006). Conclusion Segmental LP-TAE possesses stronger anticancerous effect and much less damage to liver function. Segmental LP-TAE is obviously superior than conventional LP-TAE in long term effectiveness.