TACE联合索拉非尼与TACE联合^(125)I粒子植入治疗肝细胞癌合并门静脉癌栓和动静脉瘘的比较

A comparison between TACE combined with sorafenib or 125 I seed implantation for the treatment of hepatocellular carcinoma patients with portal vein tumor thrombus and arteriovenous fistula

目的分析TACE联合索拉非尼与TACE联合^(125)I粒子植入治疗肝细胞癌合并门静脉癌栓和动静脉瘘的比较。方法2019年4月—2022年4月苏州市中西医结合医院收治的肝细胞癌合并门静脉癌栓和动静脉瘘患者62例,随机均分为对照组、观察组。对照组采用TACE联合索拉非尼的治疗方法,观察组采用TACE联合^(125)I粒子植入治疗。结果观察组临床疗效总有效率(83.8%)高于对照组[(58.0%),P<0.05];观察组血清甲胎蛋白(AFP)、血小板(PLT)、白细胞(WBC)、红细胞(RBC)指标[(213.3±8.6)ng/mL、(154.3±8.3)×10^(9)/L、(4.2±0.5)×10^(9)/L、(2.0±0.3)×10^(12)/L]均优于对照组[(117.5±6.8)ng/mL、(168.7±10.9)×10^(9)/L、(5.7±0.7)×10^(9)/L、(3.8±0.8)×10^(12)/L,P<0.05];观察组天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、白蛋白(Alb)水平[(23.5±7.8)IU/L、(30.7±4.9)IU/L、(6.7±2.7)μmol/L、(39.8±2.8)g/L]均优于对照组[(35.6±12.6)IU/L、(34.3±6.3)IU/L、(13.2±2.5)μmol/L、(36.0±2.3)g/L,P<0.05];观察组发热、腹水、恶心、呕吐、感染等并发症的发生率明显低于对照组(P<0.05)。结论与TACE联合索拉非尼相比,TACE联合植入^(125)I粒子治疗门静脉血栓和动静脉瘘的肝癌,对肝功能的损害较小,病情改善较好,缓解症状,减少并发症的发生,值得临床使用。

Objective To compare the efficacy of TACE combined with sorafenib and TACE combined with ^(125)I seed implantation for the treatment of hepatocellular carcinoma(HCC)patients with portal vein tumor thrombus and arteriovenous fistula.Methods Sixty-two patients with HCC,portal vein thrombosis,and arteriovenous fistula admitted in Suzhou Hospital of Integrated Traditional Chinese and Western Medicine between April 2019 and April 2022 were enrolled in this study.The patients in the control group were treated with TACE combined with sorafenib,and the patients in the observation group was treated with TACE combined with 125I seed implantation.Results The total effective rate in the observation group(83.8%)was higher than that in the control group[(58.0%),P<0.05];the serum levels of alpha fetoprotein(AFP),PLT,WBC,and RBC in the observation group were(213.3±8.6)ng/mL,(154.3±8.3)×10^(9)/L,(4.2±0.5)×10^(9)/L,(2.0±0.3)×10^(12)/L,respectively.Both groups were superior to the control group[(117.5±6.8)ng/mL(168.7±10.9),respectively×10^(9)/L,(5.7±0.7)×10^(9)/L,(3.8±0.8)×10^(12)/L,P<0.05];the levels of AST,ALT,TBil and Alb in the observation group were(23.5±7.8)IU/L,(30.68±4.9)IU/L,(6.7±2.7)μmol/L,and(39.8±2.8)g/L,respectively,all were better than those of(35.6±12.6)IU/L,(34.3±6.3)IU/L,(13.2±2.5)μmol/L,and(36.0±2.3)g/L in the control group(P<0.05).The incidence of complications such as fever,ascites,nausea,vomiting,and infection in the observation group was significantly lower than those in the control group(P<0.05).Conclusion Compared with TACE combined with sorafenib,TACE combined with implantation of ^(125)I particles for treating HCC patients with portal vein thrombosis and arteriovenous fistula has less impact on liver function,with a better improvement in the treatment effect,relief of symptoms and reduction of complications,which is worthy of clinical use.