药物洗脱微球经肝动脉化疗栓塞术治疗中晚期原发性肝癌的疗效

Efficacy of transcatheter arterial chemoembolization with drug eluting beads for advanced primary hepatic carcinomas

目的探讨药物洗脱微球(DEB)经肝动脉化疗栓塞术(TACE)治疗中晚期原发性肝癌(PHC)的疗效。方法选取2012年9月至2014年9月间武警湖北总队医院收治的92例中晚期PHC患者,采用随机数表法分为DEB-TACE组和C-TACE组,每组46例。DEB-TACE组给予阿霉素DEB的TACE治疗,C-TACE组给予阿霉素碘油乳剂的TACE治疗。比较两组患者术前,术后1周、1个月和2个月的肝功能、甲胎蛋白(AFP)水平及肿瘤病灶直径变化。比较分析两组患者的临床疗效、并发症发生情况及术后1、2年生存情况。结果 DEB-TACE组术后1个月和2个月时肿瘤病灶直径和血清AFP水平,均低于C-TACE组,肝功能指标改善均优于C-TACE组,差异均有统计学意义(均P<0.05)。DEB-TACE组患者术后临床总有效率(82.6%)和术后2年生存率(69.6%)均明显高于C-TACE组患者(60.9%和43.5%),并发症发生率(15.2%)明显低于C-TACE组患者(37.0%),差异均有统计学意义(均P<0.05)。两组术后1年生存率及中位生存时间比较,差异均无统计学意义(均P>0.05)。结论DEB-TACE治疗中晚期PCH疗效确切,并发症发生率低,安全可行,近期临床疗效优于C-TACE。

Objective To investigate the efficacy transcatheter arterial chemoembolization（TACE）with drug eluting beads（DEB） in the treatment of advanced primary liver cancer（PHC）. Methods Ninety-two patients with advanced PHC treated at Hubei Corps Hospital of Armed Police from September2012 to September 2014 were selected. Using a random number table,patients were divided into DEB-TACE group and C-TACE group with 46 patients in each group. Patients in the DEB-TACE group were given TACE with doxorubicin as DEB and patients in the C-TACE group were given TACE with doxorubicin lipiodol emulsion. Liver function,alpha fetoprotein（AFP） level and changes in tumor diameter were compared between the two groups before treatment and at 1 week,1 month and 2 months after the treatment. The clinical efficacy,complications and postoperative 1-and 2-year survival were also compared between the two groups. Results Compared with the C-TACE group,tumor diameter,AFP level and liver function significantly improved in the DEB-TACE group at 1 month and 2 months after treatment（P〈0. 05）. The overall efficacy rate（82. 6%） and postoperative 2-year survival rate（69. 6%） were both obviously higher in the DEB-TACE group than in the C-TACE group（60. 9% and 43. 5%,respectively） and complication rate was lower in the DEB-TACE group（15. 2%） than in the C-TACE group（37. 0%）（69. 6%,43. 5%）（P〈0. 05）. However,there was no significant difference in postoperative 1-year survival rate and median survival time between the two groups（P〉0. 05）. Conclusion DEB-TACE has high efficacy with low complication rate and high security in the treatment of advanced PCH. The short-term clinical efficacy of DEB-TACE is superior to C-TACE.