肝动脉灌注化疗栓塞(TACE)和肝动脉节段性化疗栓塞(TASCE)治疗原发性肝癌的疗效评价和与术后肝硬化发生的相关性

The content changes of serum liver fibrosis indicators after tr ansarterial chemoembolization for primary hepatic carcinoma and their clinical significance.

目的研究肝动脉灌注化疗栓塞(TACE)和肝动脉节段性化疗栓塞(TASCE)治疗原发性肝癌的疗效及其与术后肝硬化形成的相关性。方法将50例原发性肝癌患者分成两组,其中26人接受TACE治疗,另外24人接受TASCE治疗。动态观察他们治疗前后血清中HA(透明质酸)、HPC-Ⅲ(人三型前胶原)、Ⅳ.C(四型胶原)、LN(层黏蛋白)4项肝纤维化血清学指标的含量变化及肿瘤体积和甲胎蛋白(AFP)两项反应治疗效果的指标的变化。结果TACE组,治疗后上述4项肝纤维化血清学指标含量明显高于治疗前(P<0.01),肿瘤体积和AFP较治疗前有所下降。而TASCE组,治疗前后上述4项肝纤维化血清学指标的含量无明显差异(P>0.05),肿瘤体积和AFP较治疗前明显下降,且下降程度明显高于TACE组(P<0.05)。结论TASCE治疗原发性肝癌较TACE不易导致肝硬化或程度较轻,而疗效更优。

Objective To study the effect of transcathe ter arterial chemeembelization （TACE） and transcathe ter arterial segmental chemoembolization （TASCE） for primary hepatic carcinoma （PHC） on the formation of cirrhosis as well as the diffierences about the effects between TACE and TASCE. Methods Changes of four serum liver fibrosis indicators, including serum hyaluronate acid （ HA）, procollagen type - Ⅲ （ Hpc - Ⅲ ）, Collagen type - IVC （IVC） and laminin （LN） before and after TACE in 50 cases with PHC was dynamically observed. According to the location of catheter tip the cases were divided into PHA group （tip in proper hepatic artery,n = 26） and SHA group （tip in segmental hepatic artery, n = 24）. Results In PHA group, the differences in the contents of four liver fibrosis indicators before and after TACE was significant （ P 〈 0. 01）. In contrast, the differences in contents of these indicators before and after TASCE in SHA group were not significant（ P 〉0.05） . The differences in the contents of the sizes of tumor and amount of AFP before and after TACE was significant, while they are more significant in SHA group （ P 〈 0.05 ）. Conclusion The formation of liver fibrosis after TACE for treating patients with PHC was related to the target - artery used for chemeembo lization and the effect by TASCE was better than by TACE. Thus, TASCE is one of the first choices for PHC which is based TACE.