亚砷酸-碘油乳剂经动脉栓塞治疗原发性肝癌的临床研究

Clinical Study of Transarterial Chemoembolization for Primary Hepatic Carcinoma with Lipiodol-arsenic Trioxide Emulsion

目的探讨经肝动脉途径应用亚砷酸-碘油乳剂栓塞治疗原发性肝癌的临床疗效。方法58例原发性肝癌患者,应用亚砷酸注射液20mg与适量碘油混合制成亚砷酸-碘油乳剂经肝动脉途径进行化疗栓塞治疗,如果治疗或随访中肝癌病灶明显进展(病灶增大或AFP升高),则联合应用蒽环类药物,观察疗效与毒副反应。结果单纯应用亚砷酸-碘油乳剂治疗1～3次,58例患者中PR12例,NC36例,PD10例,客观有效率为20.7%,获益率为82.8%;AFP平均由(11109.36±2920.82)IU/mL降至(10001.61±2880.67)IU/mL,P>0.05。22例患者在治疗中加用蒽环类药物,16例病灶有不同程度的缩小,AFP平均由(13901.11±4862.26)IU/mL降至(5470.63±2597.79)IU/mL,P<0.05。主要毒副反应为发热、恶心呕吐、肝区疼痛、血细胞减少及转氨酶升高等,全组未见不可逆毒副反应。结论经肝动脉途径应用亚砷酸–碘油乳剂栓塞治疗原发性肝癌疗效较好,毒副反应较小,是一种较理想的微创治疗原发性肝癌的方法。

Objective To evaluate the effect and toxicity of hpiodol-arsenic trioxide emulsion on the treatment of primary hepatic carcinoma. Methods Arsenic trioxide 20mg and lipiodol were fully mixtured into lipiodol-arsenic trioxide emulsion,which were injected into hepatic artery by catheters in 58 patients with primary hepatic carcinoma. If the patients＇ conditions progressed（tumor got larger or AFP increased）,Anthracycline would be used simultaneously. The effect and toxicity were observed. Results After 1-3 times of therapy only with lipiodol-arsenic trioxide emulsion in all of 58 patients,objective response rate was 20.7% with 12 cases of PR,36 cases of NC and 10 cases of PD. AFP decreased from（ 11109.36 ± 2920.82） IU/mL to（ 10001.61 ± 2880.67） IU/mL averagely（P 〉 0.05）. Anthracycline was applied in 22 patients,and tumors got smaller in 16 cases after that. AFP decreased from （13901.11 ± 4862.26） IU/mL to（5470.63±2597.79） IU/mL averagely（P〈0.05）. The major toxic side effect were pyrexia, nausea and vomiting, pain in hepatic region,mild bone marrow depression and hepatic damage. No irreversible toxic response occurred. Conclusion Lipiodol-arsenic trioxide emulsion injection via hepatic artery by catheters is effective and less toxic to treat primary hepatic carcinoma.