肝癌根治性切除术后联合肝动脉化疗栓塞和门静脉化疗对预防复发的价值

Combined hepatic artery chemoembolization and portal vein chemotherapy after radical resection of hepatocellular carcinoma to prevent recurrence

目的 探讨在肝癌根治性切除术后联合肝动脉化疗栓塞 (hepaticarterychemoembo lization ,HACE)和门静脉化疗 (portalveinchemotherapy,PVC)对预防术后复发的价值。方法 总结 1991年 8月～ 1995年 7月收治符合根治性切除的原发性肝癌患者 81例。其中 ,术后联合HACE和PVC(Ⅰ组 ) 2 3例 ,单纯HACE(Ⅱ组 ) 30例 ,未做特殊处理 (Ⅲ组 ) 2 8例。全部患者随访 3年以上。将 3组进行对比研究。结果 患者术后 1年 ,Ⅰ组和Ⅱ组的复发率比Ⅲ组低 ,生存率比Ⅲ组高 ;术后 2年 ,Ⅰ组的复发率比Ⅱ组和Ⅲ组低 ,生存率比Ⅱ组和Ⅲ组高 ;术后 3年和 5年的复发率和生存率 ,各组的差异不显著。癌灶 >5cm、无包膜、多个癌灶及AFP >40 0 μg/L ,是导致术后复发的高危因素。 结论 在肝癌根治性切除后 ,联合HACE和PVC可以明显降低术后复发率 ,提高术后生存率 ,其结果优于术后单纯HACE ,但对远期 (3年以上 )的复发率和生存率影响不大。

Objective To study the value of combined hepatic artery chemoembolization (HACE) and portal vein chemotherapy (PVC) after radical resection of hepatocellular carcinoma (HCC) to prevent recurrence.Methods From August 1991 to July 1995, 81 HCC patients were undergone radical tumor resection. After operation, combined treatment with HACE and PVC was given in group Ⅰ (28 cases), HACE alone in group Ⅱ (30 cases), nothing in group Ⅲ (28 cases). All patients were followed up over 3 years.Results Recurrence rate at one year after surgery was significantly lower in group Ⅰ and Ⅱ than in group Ⅲ; at two years, it was lower in group I than in group Ⅱ and Ⅲ. Survival rate at one year was notably higher in group Ⅰand Ⅱthan in group Ⅲ; at 2 years, it was higher in group Ⅰthan in group Ⅱand Ⅲ. Recurrence rate and survival rate were similar in group Ⅰ and group Ⅱ at 3 and 5 years after surgery. Tumor larger than 5 cm, no capsule, multiple foci, AFP>400 μg/L were high risk factors of postoperative recurrence.Conclusion After radical resection of HCC, combined use of HACE and PVC is superior to HACE alone to reduce recurrence rate and to increase survival rate within 2 years after operation. Such remarkable difference no more exists at 3 and 5 years following operation.