聚乙烯醇肝动脉栓塞介入治疗晚期肝癌合并上消化道出血的临床观察

Interventional Therapy of Polyvinyl Alcohol Transcatheter Arterial Chemoembolization in the Treatment of Advanced Liver Cancer Combined with Upper Gastrointestinal Bleeding

目的研究聚乙烯醇(polyvinyl alcohol,PVA)肝动脉栓塞介入治疗晚期肝癌合并上消化道出血的临床观察。方法 100例晚期(ⅢB、Ⅳ期)肝癌合并上消化道患者,采用常规保肝、对症治疗以及常规经导管肝动脉化疗栓塞术(TACE)治疗的45例患者设为对照组,在此基础上联合PVA肝动脉栓塞介入治疗的55例患者设为观察组;动脉造影评价止血情况,评价两组患者近期疗效,比较两组患者治疗前后甲胎蛋白水平及肝功能,随访两年记录两组患者两年生存率,死亡率以及复发率。结果观察组成功止血53例,止血率96. 36%,对照组成功止血39例,止血率86. 67%,差异具有统计学意义(P <0. 05);观察组治疗后(CR+PR) 44例,总有效率为80. 00%,对照组(CR+PR) 30例,总有效率为66. 67%,差异具有统计学意义(P <0. 05);两组治疗后天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、甲胎蛋白(AFP)水平均显著下降,且治疗后观察组显著低于对照组,差异具有统计学意义(P <0. 05);两组两年生存率、死亡率差异无统计学意义(P> 0. 05),观察组复发率显著低于对照组,差异具有统计学意义(P <0. 05)。结论PVA肝动脉栓塞介入治疗晚期肝癌合并上消化道出血能显著提高化疗疗效,改善肝功能,降低复发率。

Objective To investigate the effect of polyvinyl alcohol( PAC) transcatheter arterial chemoembolization( TACE) in the treatment of advanced liver cancer combined with upper gastrointestinal bleeding. Methods Clinical data of 100 patients with advanced( stage ⅢB,Ⅳ) liver cancer combined with upper gastrointestinal bleeding were retrospectively analyzed.45 patients in the control group were given liver-protecting and symptomatic treatment and TACE,and based on this,55 patients in the observation group were given PVA. Arteriography was used to evaluate hemostasis. The short-term efficacy of the 2 groups was evaluated. The AFP level and liver function were compared between the 2 groups before and after treatment. The 2-year survival rate,mortality and recurrence rate of the 2 groups were recorded during the postoperative 2 years follow-up. Results The hemostasis rate was 96. 36%( 53 cases) in the observation group,which was significantly different from 86. 67%( 39 cases) in the control group( P < 0. 05);The total effective rate was 80%( 44 cases) in the observation group,which was significantly different from 66. 67%( 30 cases) in the control group( P < 0. 05);After treatment,the aspartate aminotransferase( AST),total bilirubin( TBIL),alanine aminotransferase( ALT),alpha fetoprotein( AFP) levels were significantly decreased( P < 0. 05),and the above levels in the observation group were significantly lower than those in the control group( P < 0. 05);The 2-year survival rate and mortality between the 2 groups showed no significant difference( P > 0. 05);The relapse rate in the observation group was significantly lower than that of the control group( P < 0. 05). Conclusion PAC transcatheter arterial chemoembolization is an effective way to improve the curative effect of chemotherapy,ameliorate the liver function and reduce the recurrence rate for patients with advanced liver cancer combined with upper gastrointestinal bleeding.