肝动脉化疗栓塞与肝脾动脉双栓塞治疗肝癌伴肝硬化的比较

Comparison of transcatheter hepatic arterial chemoembolization versus hepatic and splenic arterial double embolization in the treatment of hepatoma complicated with cirrhosis.

目的 比较肝动脉化疗栓塞 (A组 )和肝脾动脉双栓塞 (B组 )治疗肝癌并肝硬化病人的反应率、生存率、并发症和毒副作用。方法 确诊为肝癌并肝硬化的 6 3例病人随机分组 ,A组 31例 ,B组 32例。A组行肝动脉化疗栓塞 ,B组行肝动脉化疗栓塞加部分脾动脉栓塞。结果 A和B组有效率分别为 6 4.5 % (2 0 /31)和 6 5 .6 % (2 1/32 ) ,腹水吸收好转率分别为 33 .3 % (4/12 )和 6 9.2 % (9/13)。A组 6个月、1、2、3年的累计生存率分别是 80 .5 % (2 5 /31) ;41.9% (13/31) ,19.4% (6 /31) ,6 .5 % (2 /31) ,B组 6个 ,1、2、3年累计生存率分别是 75 .0 % (2 4/32 ) ,5 6 .2 % (18/32 ) ,34.4% (11/32 ) ,2 5 .0 % (8/32 ) ,B组术后并发 2例脾脓肿和 3例胸积液 ,并发消化道出血明显减少。结论 肝脾动脉双栓塞治疗肝癌并肝硬化能够提高病人对抗癌药的耐受性 。

? Objective To compare the effects of transcatheter hepatic arterial chemoembolization (A arm) with hepatic and splenic arterial double embolization(B arm) on hepatoma complicated with cirrhosis.Methods 63 patients were involved in this study.31 cases underwent transcatheter hepatic arterial chemoembolizations (TACE) as group A.The remaining 32 cases additionally plused transcatheter partial splenic arterial embolizations (PSE) as group B.Results An objective response rate was observed in 64.5%(20/31) of patients in group A versus 65.6%(21/32) in group B.Postoperatively 33.3%(4/12)and 69.2%(9/13) patients with ascites completely absorbed in group A and group B respectively.The cumulative survival rate of 6 months、1、2、3 yars was 80.5%(25/31)、41.9%(13/31)、19.4%(6/31) and 6.5%(2/31) in group A respectively and 75.0%(24/32),56.2%(18/32),34.4%(11/32) and 25.0%(8/32) in group B respectively.Pleural effusions were found in 3 patients and spleen abscess in 2 patietns and upper gastrointestinal bleeding in a few patients after double embolization.Conclusions The combined onestep TACE/PSE treatment can improve patient's tolerance to antiblastic drugs,reduce hemorrhagic complication and enhance patient's survival rate.