原发性肝癌外科治疗后以氟尿嘧啶+奥沙利铂+吉西他滨联合实施预防性肝动脉灌注化疗的远期疗效分析

Long-term efficacy of fluorouracil ＋ oxaliplatin ＋ gemcitabine combined with prophylactic hepatic arterial infusion chemotherapy after surgical treatment of primary hepatocellular carcinoma

目的 分析原发性肝癌外科治疗后以氟尿嘧啶＋奥沙利铂＋吉西他滨联合实施预防性肝动脉灌注化疗的整体干预效果,以期提升肝癌根治术的后续远期疗效.方法 将2011年2月-2013年11月浙江衢化医院确诊并收治的60例原发性肝细胞癌患者按照随机数字法分为研究组和对照组,每组30例.患者均首先接受肝癌根治暨肝（部分）切除手术.对照组术后单纯给予抗病毒或免疫强化治疗,不实施后续抗肿瘤治疗.研究组术后给予抗病毒或免疫强化治疗,在手术结束3周、7周后各实施1次预防性肝动脉灌注化疗,选用药物为氟尿嘧啶、奥沙利铂及吉西他滨.随访3年,统计研究组不良反应发生情况,统计2组3年内的无肝内复发生存率、无瘤生存率及综合生存率.结果 患者均完成了全程随访,并无失访病例出现.在不良反应方面,研究组患者均顺利耐受肝动脉介入灌注化疗,无明显不良反应或药物毒性出现,更无中断化疗病例.研究组3年内的无肝内复发生存率、无瘤生存率及综合生存率分别为83.33%、70.00%、86.67%,显著高于对照组的60.00%、43.33%、63.33%（P〈0.05）.结论 原发性肝细胞癌在实施肝癌根治手术后应及时给予预防性肝动脉灌注化疗,可极大地提升患者的生存率,保障远期疗效.

Objective To analyze long-term efficacy after surgical treatment of primary liver cancer with fluorouracil plus oxaliplatin plus gemcitabine joint implementation to prevent the overall intervention effect of hepatic arterial infusion chemotherapy and radical resection of hepatocellular carcinoma following ascension.Methods60 cases of primary hepatocellular carcinoma were randomly divided into study group and control group according to the random number method in our hospital from February 2011 to November2013, 30 cases in each group.All patients underwent radical resection of liver cancer and liver （partial） resection.In the control group, the patients were treated with anti viral or immune enhancement after surgery, and the follow-up treatment was not carried out.In study group were given anti-virus or immune intensive treatment and at the end of surgery 3 and 7 weeks after the implementation of a prophylactic transcatheter arterial infusion chemotherapy and selecting drug 5-FU, oxaliplatin and gemcitabine.During 3 years of follow-up, the incidence of adverse reactions in the 3 groups was statistically analyzed, and the recurrence free survival rate, disease-free survival rate and overall survival rate of the two groups were statistically analyzed.ResultsAll patients completed the follow-up, there was no loss of follow-up cases.In adverse reactions, the study group patients were successfully tolerated hepatic artery infusion chemotherapy, no obvious adverse reactions or drug toxicity, more no interruption of chemotherapy cases.The recurrence free survival rate, disease-free survival rate and overall survival rate of the study group were 83.33%, 70.00%, 86.67%, respectively, which were significantly higher than those in the control group （60.00%, 43.33%, 63.33%） （P〈0.05）.ConclusionPrimary hepatocellular carcinoma should be treated with prophylactic hepatic arterial infusion chemotherapy in time after radical operation, which can greatly improve the survival rate of patients and ensure long-term curative effect.