CT引导下^(125)I粒子切缘置入对肝癌切除术患者残余病灶的效果观察

Effect of CT guided I seed margin implantation on residual lesions in patients undergoing resection for liver cancer

目的探讨CT引导下^(125)I粒子切缘置入对肝癌切除术患者残余病灶的临床效果及对复发的影响。方法选取2016年1月至2018年1月间陕西省咸阳市第一人民医院收治的60例肝癌患者,采用随机数表法分为对照组和观察组,每组30例。对照组患者采用单纯肝癌切除术治疗,观察组患者在肝癌切除术基础上联合CT引导下^(125)I粒子切缘置入。比较两组患者的残余病灶情况与治疗效果,1年、2年的生存率与复发率,治疗前后肿瘤标志物水平和并发症情况。结果观察组患者的治疗总有效率为87.2%,高于对照组的66.7%,差异有统计学意义(P<0.05)。观察组患者的2年生存率为83.3%,高于对照组的56.7%,差异有统计学意义(P<0.05),观察组患者的2年局部复发率为16.7%,低于对照组50.0%,差异有统计学意义(P<0.05)。治疗前,两组患者的胰岛素样生长因子结合蛋白-2(IGFBP-2)、胰岛素样生长因子-Ⅱ(IGF-Ⅱ)和甲胎蛋白(AFP)水平比较,差异无统计学意义(P>0.05),治疗30d后,观察组患者的IGFBP-2、IGF-Ⅱ和AFP水平均低于对照组患者,差异均有统计学意义(均P<0.05)。观察组患者的并发症发生率为23.3%,低于对照组患者的50.0%,差异有统计学意义(P<0.05)。结论肝癌患者应用切除术后联合^(125)I粒子切缘置入治疗,能够减少残余病灶的进展,提高治疗效率,减少复发,提高患者生存率,效果显著。

Objective To evaluate the effect of CT guided 125 I seed margin implantation on residual lesions and recurrence in patients undergoing hepatectomy.Methods Sixty patients with liver cancer treated at Xianyang First People’s Hospital from January 2016 to January 2018 were selected and were divided into an observation group and a control group with 30 patients in each group.Patients in the observation group were treated with 125 I seed margin implantation under the guidance of CT besides hepatectomy.Patients in the control group only underwent hepatectomy.The residual lesions and treatment efficacy 1-year and 2-year survival rate and recurrence rate the levels of tumor markers before and after treatment and the incidence of complications were compared between the two groups.Results The overall efficacy rate was87.2%in the observation group which was significantly higher than 66.7%of the control group(P<0.05).The 2-year survival rate was 83.3%in the observation group which was significantly higher than56.7%of the control group(P<0.05).The 2-year local recurrence rate was 16.7%in the observation group which was significantly lower than 50.0%of the control group(P<0.05).Before the treatment,there was no significant difference in insulin-like growth factor binding protein 2(IGFBP2),insulin like growth factor-Ⅱ(IGF-Ⅱ)and alpha-fetoprotein(AFP)between the two groups(P>0.05).At 30 d after the treatment,IGFBP-2,IGF-II and AFP levels were lower in the observation group than in the control group(all P<0.05).The incidence of was 23.3%in the observation group than in 50.0%of the control group(P<0.05).The incidence of complications was 23.3%in the observation group which was higher than 50.0%of the control group(P<0.05).Conclusion Hepatectomy combined with 125 I seed margin implantation in the treatment of liver cancer can reduce the progression of residual lesions,improve treatment efficiency,reduce recurrence,and improve the long-term survival rate.