原发性肝癌患者肝动脉化疗栓塞术后肝区疼痛的临床意义

The clinical significance of liver pain in patients with primary hepatocellular carcinoma after transcatheter arterial chemoembolization

目的探讨肝动脉化疗栓塞术(TACE)后肝区疼痛与近期疗效的关系。方法118例原发性肝癌患者按照TACE术后肝区疼痛程度分为两组,A组无明显肝区疼痛,B组有明显肝区疼痛,比较两组病灶在首次介入治疗后的反应,分析TACE后肝区疼痛的相关因素。结果首次介入术后4～6周行CT检查,按RECIST标准评价疗效,A、B两组CR、PR、SD、PD分别为0、1.45%、88.41%、10.14%和0、14.29%、81.63%、4.08%,有效率OR(CR+PR)比较差异有统计学意义(P=0.0087)。分析术后疼痛原因可能与术前病灶血供、包膜、肝硬化和术后病灶碘油充填类型有关,其中碘油沉积分型与疼痛分级呈负相关(r=-0.539,P<0.01)。结论介入术后肝区疼痛多提示患者肿瘤栓塞效果好、预后好。充分认识TACE后肝区疼痛与疗效相关性具有重要临床意义。

Objective To investigate the relationship between the liver pain and the short-term curative effect in patients with primary hepatocellular carcinoma（HCC） after transcatheter arterial chemoem-bolization（TACE）.Methods According to the degree of liver pain,118 HCC patients after the initial TACE treatment were divided into two groups： group A（with no complaint of serious liver pain） and group B（complaining of severe liver pain）.Short-term curative effects at the fourth and sixth week after initial TACE were compared between the two groups,and the factors related to the liver pain after TACE were analyzed.Results Four to six weeks after the initial TACE,CT scan was performed in all patients.Based on the RECIST criteria the short-term curative effects were evaluated.The CR,PR,SD,PD of group A and B were 0%,1.45%,88.41%,10.14% and 0%,14.29%,81.63%,4.08%,respectively.The difference in OR（CR ＋ PR） between two groups was statistically significant（P=0.0087）.The postoperative liver pain was probably related to the preoperative tumor blood supply pattern,the tumor capsule,the cirrhosis and the type of iodized oil deposit.The type of iodized oil deposit showed a negative correlation with the grade of liver pain（r=-0.539,P〈0.001）.Conclusion The liver pain occurred after TACE is a useful suggestive sign,which indicates that a good curative result will be obtained.It is of clinical significance to make a full understanding of the relationship between the liver pain and the therapeutic effect.