不同肝功能分级的大肝癌TACE碘化油剂量与疗效的相关性研究

Correlative study of lipiodol dose in evaluating the effect of TACE for large hepatocellular carcinoma of different liver function

目的:探讨肝功能Child A级与Child B级TACE时,碘化油剂量对大肝癌的疗效影响。方法:回顾性分析106例大肝癌患者,按照碘化油用量分为A、B两组,术后4周CT扫描观察碘化油聚积形式、检测AFP水平和进行肝功能分级,并对1、2、3年生存率进行分析。结果:A组术后碘化油聚积为第一类型、第二类型的数量和血清AFP下降强度均明显高于B组,但术后肝功能分级较B组差,比较12、、3年生存率,ChildA级的两组有显著差异,A组高于B组。结论:肝功能分级为Child B级的大肝癌患者,为避免肝功能进一步损害,应适当减少栓塞剂的用量;而肝功能级别为Child A的肝癌患者,可以适当的加大碘化油栓塞的剂量,能获得较满意的近期和远期疗效。

Objective： To investigate the influence of lipiodol dose in evaluating the effect of TACE for large hepatocellular carcinoma of different liver function, including Child A and Child B. Methods： Analysis 106 patients with large hepatocellular carcinoma were divided into two groups according lipiodol dose. Four weeks after TACE, the liver function evaluated with Child-Pugh scores, the lipiodol accumulation detected by CF, and AFP test were performed. Then the 1-,2-, 3-year cumulative survival rates of the patients were analyzed. Results： More type I and type H lipiodol accumulations in CF scan and serum AFP reduce degrees after 4 weeks of TACE were seen in the group A patients than those in the group B patients. But the Child-Pngh score was increased than those in the group B patients, The 1-, 2-, 3-year survival rates of group A patients with Child grade A were respectively better than those of group B. Conclusion： In treatment of a Child grade B patient by TACE, low-dose lipiodol should be used to avoid the liver function harmful. For the patients with large tumor of Child grade A liver function, to acquire the better the near and future effect, oily chemoembolization with high-dose lipiodol is recommended.