栓塞微球联合碘化油化疗栓塞治疗肝癌的临床研究

Clinical study of hepatocellular carcinoma treated by embolization of microspheres combined with lipiodol

目的评价栓塞微球联合碘化油化疗栓塞治疗原发性肝癌的临床疗效。方法回顾性分析41例经确诊的原发性肝癌患者:对照组20例,先行灌注艾恒和吡柔比星,然后推注碘化油吡柔比星乳化剂直至血流中断且肿瘤染色消失;Embosphere微球组21例,灌注同样化疗药并注入少量碘化油+吡柔比星乳化剂后,注入Embosphere微球至靶血管闭塞,肿瘤染色消失。分别对2组患者的栓塞次数,手术前后肝功能、血清甲胎蛋白(AFP)水平、肿瘤大小的改变情况,栓塞相关并发症,术后生活质量及生存率进行比较。结果微球组患者接受治疗的次数明显少于对照组患者,微球组总有效率为38.1%,获益率为90.5%;对照组总有效率为30.0%,获益率为80.0%。2组患者治疗后AFP明显降低,差异有统计学意义。治疗前后KPS评分比较,微球组要高于对照组(P<0.05)。微球组患者术后生存率要高于单纯碘油组,但两者之间差异无统计学意义。结论 Embosphere栓塞微球联合化疗栓塞治疗肝癌比单纯碘化油化疗栓塞更加有效,能明显提高患者术后生活质量和近期生存率,尤其对巨块型肝癌疗效明显。

Objective To evaluate the clinical efficacy of transcatheter arterial chemoembolization（TACE） therapy for hepatocellular carcinoma（HCC） after embolization of embosphere combined with lipiodol.Methods The clinical data of 41 patients with HCC who were treated by TACE were reviewed retrospectively： 20 patients in the control group were infused with oxaliplatin and pirarubicin,then injected emulsion of pirarubicin and iodized oil until the blood flow interruption and the disappearance of tumor staining;21 patients in the microspheres group were perfused with the same medicine and a small amount of pirarub icin lipiodol emulsion,and then embosphere microspheres were injected to the target vessels till it was occluded.The embolism times,patients′ liver function,serum alpha-fetoprotein level（AFP）,responses of tumor,procedure-related complications,quality of life and the cumulative survival rates were analyzed respectively befone and after therapy.Results Transarterial embolization courses for the microspheres group were lower than the control group.The overall response rate in microspheres group was 38.1%,clinical benefit rate was 90.5%,and the control gvoup were 30.0%,80.0% respectively.After TACE,there was a significant difference in the decrease of AFP level.The KPS score in the microspheres group were greater than those of patients in the control group,the difference was statistically significant（P〈0.05）.The cumulative survival rates of the microspheres were higher than the contol group,but there is no statistically significant.Conclusion Embolization with embosphere microspheres and lipiodol for hepatocellular carcinoma was more effective than lipiodol alone,and can improve the life quality and the short-term survival rates,especially for bulky hepatocellular carcinoma.