经导管动脉内化疗栓塞术联合静脉注射三氧化二砷治疗原发性肝癌的临床研究

A clinical study of interventional chemoembolization therapy combined with intravenous injection of arsenic trioxide in the treatment of primary hepatic carcinoma

目的观察经导管动脉内化疗栓塞术(transcatheter arterial chemoembolization,TACE)联合静脉注射三氧化二砷治疗原发性肝癌的临床疗效。方法选取2013年5月至2014年5月在我院治疗的原发性肝癌患者124例,根据治疗方法的不同分为观察组与对照组各62例。观察组给予注射三氧化二砷10 mg溶于500 ml生理盐水中静脉滴注7 d后休息10 d,为一个治疗周期,4个周期为一个疗程;同时进行TACE治疗,药物为表阿霉素40 mg+超液化碘油10 ml,充分乳化后注射入肿瘤周围的供血管,4~8 W为一个TACE周期。对照组患者则仅采用TACE治疗,治疗方案同观察组。所有患者治疗3个TACE周期后评价疗效,0.5、1、2年生存率,生活质量和不良反应的发生情况。结果观察组与对照组的有效率分别是70.97%(44/62)与58.06%(36/62),差异有统计学意义(P<0.05);观察组与对照组的中位生存期分别为8.36月和8.11月,平均生存期12.96月和8.79月,半年生存率分别为88.70%与83.87%,差异无统计学意义(P>0.05);两组患者1年和2年生存率分别为62.90%、27.42%与45.16%、17.74%,差异有统计学意义(P<0.05);观察组患者改善率为77.42%高于对照组的56.45%(P<0.05);两组患者在治疗过程中均出现了谷草转氨酶与谷丙转氨酶的升高、白蛋白降低、胆红素以及心电图异常的不良反应,差异有统计学意义(P<0.05)。结论 TACE联合静脉注射三氧化二砷治疗原发性肝癌具有很好的疗效,能够提高患者的生存期,改善患者的生活质量,减少治疗所带来的不良反应,具有重要的临床价值。

Objective To observe the clinical effect of transcatheter arterial chemoembolization （ TACE） combined with intra-venous arsenic trioxide in the treatment of primary liver cancer .Methods From May 2013 to May 2014 ,124 patients with primary hep-atocellular carcinoma （ HCC） treated in our hospital were divided into observation group and control group according to the different treatment methods,62 in each group.The observation group was given intravenous injection of arsenic trioxide 40 mg dissolved in 500 ml saline.One treatment cycle was intravenous drip for 7 days and rest for 10 days.Four cycles were as one treatment course .Simultaneous-ly,the patients received the TACE .The chemotherapeutic drugs were epirubicin 45 mg,oxaliplatin 75 mg and iodized oil 15 mg that were injected into the blood supply around the tumor parallel embolization after sufficient emulsification .The treatment cycle was 4-8 weeks. The control group received the TCEA only .All patients were evaluated after 3 cycles of the treatment including survival rate ,quality of life and incidence of adverse events in half-year,1-year and 2-years.Results The effective rate of the observation group and the con-trol group was 70.97%（44/62） and 58.06%（36/62）,respectively.The difference was statistically significant （P〈0.05）.The me-dian survival time of the observation group and the control group were 8.33 months and 8.11 months,respectively;the mean survival time was 12.96 months and 8.79 months,respectively,and the half-year survival rates were 88.70%and 83.87%,respectively.All the differences were not significant （ P〉0.05 ） .However ,the 1-year and 2-year survival rates were 62.90%and 27.42%,respectively ,in the observation group that were significantly higher than those in the control group were （ 45.16% and 17.74%, respectively , P 〈0.05）.The improvement rate of the observation group was 77.42%,which was higher than that of the control group （56.45%,P 〈0.05）.Furthermore,in the observation group and the control group ,there were increased aspartate aminotransferase and alanine amin-otransferase,decreased albumin and abnormalities in bilirubin and ECG in the both groups when compared to before treatment （ P 〈0.05）.Conclusion The combination of TACE with intravenous injection of arsenic trioxide has a good effect in the treatment of pri -mary liver cancer .It can increase the survival of patients ,improve the quality of life and reduce the adverse reactions .It has important clinical value .