富血供原发性肝癌周边部双重化疗栓塞的临床应用研究

Clinical outcomes of double chemoembolization for primary hepatocellular carcinoma with rich blood supply

目的:探讨碘化油+明胶海绵颗粒+化疗药物混合剂双重化疗栓塞富血供原发性肝癌周边部的临床应用价值。方法:选择影像学显示为富血供的59例巨块/结节型原发性肝癌患者,随机分为两组进行不同栓塞方法介入治疗。A组30例(观察组),先行供血动脉灌注化疗,后行碘化油+化疗药乳剂化疗栓塞,血流稍变慢后,使用碘化油+明胶海绵颗粒+化疗药物混合剂双重化疗栓塞肝癌周边部;B组29例(对照组),采用常规介入治疗,即先行肝癌供血动脉灌注化疗,后行碘化油+化疗药乳剂化疗栓塞,供血动脉较粗者追加少许明胶海绵颗粒栓塞。结果:A组AFP阳性19例,治疗后下降16例,下降率84.2%(16/19);B组AFP阳性21例,治疗后下降11例,下降率52.4%(11/21);A组部分缓解率56.7%(17/30),B组部分缓解率27.6%(8/29)。A组1、2、3年生存率分别为63.3%(19/30)、43.3%(13/30)、30%(9/30),B组为34.4%(10/29)、24.1%(7/29)、17.2%(5/29)。两组间在AFP阳性患者AFP值的下降、部分缓解率、生存率方面差异有统计学意义(P1=0.032,P2=0.024,P3=0.001)。结论:碘化油+明胶海绵颗粒+化疗药物混合剂双重化疗栓塞富血供原发性肝癌周边部较常规介入治疗更有效。

Objective： To evaluate the clinical efficacies of double transarterial chemoembolization of the primary liver carcinoma with peripherally wellsupplied blood by supplemental using gelatin sponge particles and iodized oil.Methods： A total of 59 patients of giant / nodular primary hepatocellular carcinoma displaying rich blood supply on hepatic angiography were recruited,and randomized into group A（ n = 30） and group B（ n = 29）. Patients in group A underwent initial transarterial chemoembolization,followed by chemoembolization with gelatin sponge particles plus anticancer drugs（ emulsion）. Supplemental iodized oil and gelatin sponge particles were used with chemotherapeutic drugs to obstruct the peripheral blood supply to the tumors upon the blood supply being slowed down. Patients in group B were given conventional chemoembolization,followed by iodized oil and chemotherapeutic drugs,and small dose of gelatin sponge particles were used in patients with relatively larger arteries. Positive alpha fetoprotein（ AFP）,clinical response and overall survival rate were analyzed and compared between groups. Results： Of 19 and 21 patients with positive alpha fetoprotein in group A and group B,the AFP levels were declined in 16（ 84.2%; 16 / 19） and in 11（ 52. 4%; 11 / 21） after therapy. Partial clinical response was 56. 7%（ 17 / 30） for group A and27.6%（ 8 / 29） for group B. Survival rate of 1-,2- and 3-year was 63.3%（ 19 / 30）,43.3%（ 13 / 30） and 30%（ 9 / 30）; 34.4%（ 10 / 29）,24.1%（ 7 / 29）and 17.2%（ 5 / 29）,respectively for group A and group B（ P = 0.024）. The two groups were significantly different regarding the declined AFP,partial clinical response and survival rate（ P1 = 0.032,P2 = 0.024,P3 = 0.001,respectively）. Conclusion： Transarterial chemoembolization with supplemental use of gelatin sponge particles and iodized oil may lead to better chemotherapeutic efficacies than conventional chemoembolization for primary unresectable hepatocellular carcinoma with rich blood feeding arteries.