原发性肝癌外科手术联合血管内介入治疗的意义

The significance of surgery combined with interventional therapy in primary hepatic carcinoma

目的：探讨原发性肝癌外科联合血管内介入治疗的意义。方法：69例原发性肝癌患者，41例先行手术切除，术后行TAI或TACE；28例先行TACE，7天-1月内再行手术切除，术后1—6月内再行TAI或TACE治疗。结果：全组病例共行236次TM或TACE，最多者11次，最少者1次，平均3．4次。手术及介入治疗均成功，未出现并发症。先行手术组1～2个月造影残癌者9例（9／41），2年内发现复发病灶18例。先行TACE组手术后近期未发现残余病灶，2年内肿瘤复发为7例。AFP术后降至正常或接近正常范围为56例，术后存活率为：半年100％，1年89．3％，2年68．0％，3年57．3％，5年43．8％。结论：术前行TACE有利于争取手术机会和手术根治，防止术后复发。介入治疗和手术结合是提高肝癌整体疗效及病人存活率的重要方法。

Objective：To explore the value of surgery combined with interventional therapy in primary hepatic carcinoma.Methods： There were 69 cases of primary hepatic carcinoma. Surgical operation was done, and then TAI or TACE was carried out in 41 eases （group 1）. TACE was carried out first, and then surgical operation was done between 7 days and 1 month, TAI or TACE was carried out again 1 to 6 months in 28 cases （group 2）. All cases received 236 times of TAI or TACE （the most 11 times, lest 1 time, average 3.4 times）. Surgical operation and interventional therapy was successful done and with no complications. Remnant cancer was found in 9 cases with angiography 1 - 2 months later （9/41）, and in 18 cases recurrence cancer was found after 2 years in group 1. No remnant cancer was found, and recurrence cancer was found in 7 patients after 2 years in group 2. AFP level was in normal range or nearly normal range after surgical operation. Survival rate was 100% in half year, 89.3% in 1 year, 68.0% in 2 years, 57.3% in 3 years and 43.8% in 5 years. Conclusion： Pre-operational TACE could make more opportunity to radical surgery, and it also could prevent recurrence of the tumor. The combination of surgery and TACE is an important way in improvement therapy effect and survival rate of the patient.