原发性肝癌根治切除后介入治疗对复发防治的疗效评价

Appraisal of postoperative transcatheter arterial chemoembolization (TACE) for prevention and treatment of hepatocellular carcinoma recurrence

目的 探讨原发性肝癌根治切除术后肝动脉介入综合治疗对肝癌复发的防治效果。方法 根治术后定期复查肝功能、甲胎蛋白 (AFP)、B超、胸片等 ,于术后 2个月按Seldinger法行肝动脉造影或碘化油CT检查 ,根据有无残癌分为两组 :无残癌者为预防组 ,有残癌者为治疗组。预防组术后 2个月和 5个月分别行预防量的肝动脉化疗栓塞治疗 ,以观察复发率和生存期 ;治疗组按常规量行肝动脉化疗栓塞治疗 ,每 2个月重复 1次以观察生存期。结果 10 9例根治性切除后原发性肝癌患者 ,术后观察最短 6个月 ,最长 45个月。预防组 6 8例 ,占根治切除术的 6 2 .4% ,其中 10例复发 ,复发率为 14.7%。其 1,2 ,3年累计复发率分别为 7.4%、13.2 %和 14.7% ,1,2 ,3年术后生存率分别为10 0 %、93.4%和 85 .7%。治疗组 41例 ,占根治切除术的 37.6 %。其术后 1,2 ,3年生存率分别为78.1%、5 7.7%和 5 7.7% ,与预防组相比 ,差异有显著性。此外 ,肿瘤 >5cm、有 2个以上结节、卫星灶、包膜不完整或缺如和癌栓存在均影响手术切除的彻底性。根治切除术后 ,AFP不转阴、肝血管造影和碘化油CT是早期发现残癌和复发的最敏感的检测手段。结论 原发性肝癌根治切除术后的介入综合治疗是预防复发的有效手段 。

Objective To evaluate the effect of postoperative TACE for prevention and treatment of hepatocellular carcinoma (HCC) recurrence after radical resection.Methods From Jan. 1995 through March 1998, 109 HCC patients after radical resection were followed up with serum AFP, liver US and CT, chest X ray film, hepatic artery angiography, etc. They were divided into 2 groups. Patients in group A ( n =68) with no residual tumor were given prophylactic TACE treatment, 1～2 times at the second and fifth month after operation. Patients in group B ( n =41) with residual tumor left were treated with regular TACE, once every 2 months. The 2 groups of patients were followed up for 6～45 months after operation.Results In group A, the real curative resection rate was 62.4%. Tumor recurrence was found in 10 of the 68 patients, with a total recurrence rate of 14.7% within 3 years after radical resection. The 1 , 2 , and 3 year cumulative recurrence rate was 7.4%, 13.2% and 14.7%, respectively. The 1 , 2 , and 3 year survival rate was 100%, 93.4% and 85.7%, respectively, while that in group B was 78.1%, 57.7% and 57.7%, respectively. The differences between the 2 groups of patients were statistically significant. The predictive pathological factors hampering completeness of tumor resection were: tumor size >5 cm, more than 2 tumor nodules, the presence of satellite nodules, tumor with partial or without encapsulation and tumor thrombus in portal vein. Hepatic artery angiography with LP CT and maintenance of high serum AFP level were the most sensitive methods for detecting residual tumor after operation.Conclusion Post operative TACE is very useful for prevention and treatment of HCC recurrence. It helps improve survival of surgically treated HCC patients.