肝动脉栓塞及肝动脉-门静脉双重栓塞化疗治疗中晚期原发性肝癌的疗效比较

Comparison of Therapeutic Effects between Transcatheter Arterial Chemoembolization and Transcatheter Arterial-Portal Venous Double Chemoembolization in Treatment of Moderate and Advanced Stages of Primary Liver Carcinoma

背景与目的:临床资料表明,肝的血液由肝动脉和门静脉双重供应,肝癌患者单纯应用肝动脉栓塞化疗(transcatheterarterialchemoembolization,TACE)难以控制肿瘤。本研究旨在探讨经肝动脉行动-门脉双重栓塞化疗(portalvenouschemoembolization,PVCE)治疗中、晚期原发性肝癌的临床价值。方法:回顾性分析1995年7月～1997年7月经肝动脉行动-门脉双重栓塞化疗对58例中、晚期原发性肝癌(TACE+PVCE组)的疗效,与同期行单纯肝动脉栓塞化疗的118例中、晚期原发性肝癌(TACE组)的疗效对比。结果:(1)TACE+PVCE组治疗有效率86.2%,显效率31.0%;TACE组治疗有效率69.5%,显效率13.6%(P<0.05)。(2)TACE+PVCE组半年生存率93.1%,TACE组72.0%;TACE+PVCE组1、4年的生存率分别为43.1%、6.9%;TACE组分别为51.7%、5.1%。寿命表法分析两组患者半年生存率间差异有显著性,1、2、3、4年生存率间差异无显著性。(3)两组患者栓塞后均有发热、腹痛、白细胞下降、肝功能受损发生,TACE+PVCE组肝功能受损较严.-重,甚至可出现黄疸、腹水,肝功能受损程度与碘油用量呈正相关。结论:经肝动脉行动-门脉双重栓塞化疗治疗中、晚期原发性肝癌的短期疗效明显优于单纯行肝动脉栓塞化疗,但中、长期疗效差异无显著性。

BACKGROUND &OBJECTIVE: Many clinic data showed that it is difficult to control primary liver carcinoma (PLC) by transcatheter arterial chemoembolization (TACE) alone due to existence of double blood supply of liver by hepatic artery and portal vein. This study was designed to evaluate the efficacy of transcatheter arterial chemoembolization combined with portal venous chemoembolization (PVCE) in the treatment of moderate and advanced stages of PLC. METHODS: Fifty eight cases of moderate and advanced stages of PLC were treated with a combination of TACE and PVCE (TACE/PVCE group) and 118 patients with moderate and advanced stages of PLC were treated with TACE alone (TACE group). RESULTS: (1)The total response rates were 86.2%in TACE+PVCE group and 69.5%in TACE group. The remarkable response rates were 31.0 %in TACE/PVCE group and 13.6%in TACE group (P< 0.05). (2)The half year survival rates were 93.1%in TACE/PVCE group and 72.0%in TACE group (P< 0.05). The 1 year survival rates were 43.1%in TACE/PVCE group and 51.7%in TACE group. The 4 year survival rates were 6.9%in TACE/PVCE group and 5.1%in TACE group (P >0.05). (3) Side effects included fever, bellyache, white blood cell drop, hypohepatia, jaundice,and ascites. The degree of liver damage was positively associated with the amount of iodized oil. CONCLUSION: The combination of TACE and PVCE appears to promote the short term efficacy but not the long term efficacy, compared with TACE alone for patients with moderate and advanced PLC.