综合序贯介入治疗结直肠癌肝转移63例疗效观察

Analysis of Sequential Interventional Therapy for Liver Metastasis from Colorectal Cancer

【目的】探讨综合序贯介入治疗结直肠癌肝转移的临床效果。【方法】选择2013年10月至2016年10月本院收治的126例结直肠癌肝转移患者为研究对象，根据治疗方式的不同将其分为化疗组与综合组，每组各63例。化疗组发现患者出现肝转移瘤后行FOLFOX化疗方案。综合组发现患者出现肝转移瘤后、第3个月、第6个月行经肝动脉化疗栓塞（TACE）联合射频消融术（RFA）治疗，术中行造影检查，对患者的肿瘤病灶数量与大小给予化疗药物，于化疗结束后应用碘化油乳化剂经超微导管行栓塞治疗。比较两组患者的治疗效果、毒副作用与生存率。【结果】综合组完全缓解（CR）、部分缓解（PR）所占比例显著高于化疗组，疾病进展（PD）所占比例显著低于化疗组，治疗客观有效率显著高于化疗组，差异有统计学意义（P〈0．05）。综合组血清甲胎蛋白（AFP）阳性者恢复正常所占比例高于化疗组，升高、无变化所占比例的显著低于化疗组（P〈0．05）；两组血清下降所占比例比较，差异无统计学意义（P〉0．05）。综合组6个月生存率、12个月生存率显著高于化疗组，生存时间明显高于化疗组，差异均具有统计学意义（P〈0．05）。化疗组患者不良反应发生率为25．40％（16／63）高于综合组的20．63％（13／63），但两组比较差异无统计学意义（χ2=0．224，P=0．636〉0．05）。【结论】因无法手术切除治疗的结直肠癌肝转移患者采用综合序贯介入治疗临床效果较好，可延长患者生存时间，减少化疗带来的不良作用，值得临床推广使用。

[Objective]To investigate the clinical effect of sequential interventional therapy for colorectal liver metastases of colorectal cancer and to explore an effective treatment for improving the prognosis. [Methods]A total of 126 colorectal cancer patients with liver metastasis who were treated in our hospital from October 2013 to October 2016 were selected as study subjects. According to the different treatment methods, they were divided into a routine chemotherapy group and sequential interventional therapy group, With 63 cases in each group. Patients in chemotherapy group received FOLFOX chemotherapy while patients in the sequential interventioni group were treated with radiofrequency catheter ablation （TACE） and radiofrequency catheter ablation （RFA） at the third month and the sixth month after they developed liver metastases, followed by iodized oil emulsifier embolization via catheterization at the end of chemotherapy. The therapeutic effect, side effects and survival rate of the two groups were then compared.[Results]The proportion of complete remission （CR） and partial remission （PR） in the sequential intervention group was significantly higher than that in the chemotherapy group, and the disease progression （PD） rate was significantly lower than that in the chemotherapy group. The treatment efficacy rate of the sequential intervention group was significantly higher than that of the chemotherapy group （ P 〈0.05）; The rate of positive serum alpha-fetoprotein （AFP） returning to normal level in the sequential intervention group was higher than that in the chemotherapy group （ P 〈0.05）.The no change rate and increasing rate of AFP in sequential intervention group were significantly lower than those in the chemotherapy group （ P 〈0.05） ; there was no difference in the serum descending rate （ P 〈0.05）. The 6-month, 12-month survival rate and median survival time in the sequential intervention group were significantly higher than those in the chemotherapy group （ P 〈0.05）; There was no significant difference in the incidence of side effects between the two groups （25.4% vs 20.63 %, χ2 = 0.224, P = 0.636 ; P 〉 0.05）. [Conclusion]Sequential interventional therapy in unresectable eolorectal cancer patients with live metastasis is a reliable treatment method. It can extend the survival time of patients and reduce the adverse effects of chemotherapy. It is worth promoting sequential interventional therapy in clinical application.