原发性肝癌介入性靶向热化疗的临床应用研究

Clinical application of thermo-chemoembolization for primary hepatocellular carcinoma

目的:探讨原发性肝癌动脉栓塞化疗(TACE)基础上热化疗热碘油栓塞的临床应用疗效及安全性。方法:41例原发性肝癌患者分为2组:①肝动脉热化疗热碘油栓塞组(热疗组)20例。②单纯TACE组(常温组)21例。2组病例肿瘤最大径分别为3～16 cm(平均7.09 cm);2.5～13 cm(平均7.43 cm)。多发性病灶以其中最大径为观察目标,2组病例的平均年龄、性别、主瘤大小、肝功能分级和KPS评分差异无统计学意义(P>0.05)。观察治疗前后患者临床症状、肿瘤标志物(AFP)、肿瘤影像学(CT或MRI)、肝功能等变化,对患者进行随访以评估治疗后肿瘤栓塞坏死状况、肿瘤大小、肝功能和生存期情况。全部患者随访3～24月。结果:热疗组治疗前后肿瘤最大横截面积中位数分别为30 cm^2、14.87 cm^2;AFP治疗前后测定值分别为(1 522.8±1 067.1)ng/ml、(355.6±321.4)ng/m1。常温组治疗前后肿瘤最大横截面积中位数分别为56 cm^2、44.8 cm^2;AFP治疗前后测定值分别为(1 164.5±891.4)ng/ml、(211.3±259.6)ng/ml,各组治疗前后比较,差异有统计学意义(P<0.05)。但热疗组和常温组比较,二者差异无统计学意义(P>0.05)。2组间术后肝功能Child分级、KPS评分及肝功能实验室检查结果比较差异均无统计学意义(P均>0.05)。3、6、12、18、24月生存率,热疗组分别为100%、90%、75%、40%、20%,常温组分别为100%、66.67%、42.68%、28.57%、9.52%,2组比较,差异有统计学意义(P<0.05)。结论:热疗组治疗原发性肝癌的疗效明显优于常温组,可提高肿瘤坏死率而肝功能无明显损害,并能延长患者生存期。

Objective：To assess the clinical efficacy and safety of thermo-chemoembolization for the treatment of primary hepatocellular carcinoma. Methods：A total of 41 cases of primary liver cancer were randomly divided into two groups：① transcatheter hepatic arterial chemoembolization （TACE） with heated liquid mixed with chemicals and lipiodol group （study group, n= 20）;②common TACE with non-heated mixture group （control group, n=21）. The tumor size of the two groups were 3-16 cm （mean 7.09 cm） for the study group and 2.5-13 cm （mean 7.43 cm） for the control group, respectively. The largest diameter for the multiple tumors were measured. The preoperative data including age, sex, tumor size, liver function, and KPS score of the two groups showed no statistical significance （ P〉0.05）. Patients pre and postoperative clinical parameters such as symp- tom, tumor marker （AFP）, tumor images （CT or MRI）, liver function, survival time, etc. were recorded. All patients were followed up for 3-24 months. Results：Study group： median tumor size and AFP values before and after treatment were 30 cm^2 , （1522. 8±1067. 1）ng/ml and 14. 87 cm^2 , （355.6± 321.4） ng/ml, respectively. While for the control group, these data were 56 cm^2 ,（1164. 5±891.4）ng/ml and 44.8 cm^2 ,（211.3±259.6）ng/ml,respectively. The differences before and after treatment were statistically significant （ P〈0.05） for the both groups. However, besides these two parameters, liver function change also showed no significance（ P〉0.05） between these groups. The survival rate of 3, 6, 12, 18, 24 months of study and control group were 100%, 90%, 75%, 40%, 20% ; 100%, 66.67M, 42.68%, 28.57%, 9.52% respectively, the difference was statistically significant （ P 〈0. 05）. Conclusion：The efficacy of the thermo-chcmoembolization for the treatment of primary liver cancer is better than that with common TACE without increasing the damage of the liver. It can accelerate tumor necrosis and prolong survival.