多模式介入治疗伴失代偿性肝硬化肝癌  

The study of treatment for hepatocellular carcinoma with decompensate cirrhosis by multi-interventional modes

作　　者：倪鎏达[1] 周峰[1] 傅青春[1] 陈成伟[1] 王晓今[1] 

机构地区：[1]上海解放军第八五医院南京军区肝病临床研究中心,200235

出　　处：《肝脏》2008年第3期195-198,共4页Chinese Hepatology

摘　　要：目的探讨伴失代偿性肝硬化肝细胞癌（HCC）多模式介入治疗的临床价值。方法在内科治疗稳定后，147例伴肝硬化失代偿HCC患者接受不同介入模式的治疗，其中36例采用肝动脉化学栓塞（TACE，A组），54例采用肝动脉节段性化学栓塞治疗（S-TACE，B组），57例采用S-TACE后序贯射频消融（RFA）或（加）无水乙醇局部注射（PEI）的多模式介入治疗（C组）。结果随访6～72月，A组、B组和C组患者中位生存期分别为4．1月、9．4月（P〈0．05）和13．7月（P〈0．01和P〈0．05）；累计生存率6个月分别为22．2％、51．8％（P〈0．05）和75．44％（P〈0．01），12个月分别为5．6％、31．5％（P〈0．05）和40．35％（P〈0．05），24个月分别为0、9．3％和19．30％（P〈0．05）；AFP复常率分别为23．3％、60．5％（P〈0．05）和71．1％（P〈0．01）；瘤体缩小（〉50％）分别占8．3％、31．5％（P〈0．05）和50．9％（P〈0．01）。单变量分析显示包括HBVDNA在内的14项因素与预后显著相关，多因素Cox模型分析显示肝功能Child—Pugh分级、吲哚氰绿15min储留率（ICGR，s）、门静脉癌栓、介入模式及甲胎蛋白术前升高者介入后变化与预后显著相关。结论多模式介入治疗是伴肝功能失代偿HCC的有效治疗方法，对HBVDNA阳性患者应该考虑抗病毒治疗。Objective To evaluate the efficiency of multi-interventional modes in treating primary hepatocellular carcinoma with decompensate cirrhosis. Methods 147 cases with hepatocellular carcinoma accompanied by decompensate cirrhosis were undertaken transcatheter arterial chemo-embolization （TACE, Group A, N = 36） , segmental transcatheter arterial chemo-embolization （S-TACE, Group B, N = 54） and S-TACE added on radiofrequency ablation（RFA）or/added on ercutaneous ethanol injection （PEI）（multi-interventional modes therapy , Group C, N = 57）. Univariate analysis and multivariate Cox proportional hazard regression model were used to analyze the factors affecting the prognosis. Results All patients of A, B,C groups had been followed up for 6 months to 72 months, with median survival time of 4.1 months, 9. 4 months（P〈0.05） and 13.7 months（P〈0.01 and P〈0.05 ） respectively. The overall cumulative survival rates in group A,group B and group C were 22.22% ,51.85%（P〈0.05）and 75.44%（ P〈0.01）for 6 months;5.56% ,31.48% （P〈0.05）and40.35%（P〈0.05）for 12 months;0,9.26% and 19.30%（P〈0.05）for 24 months respectively. AFP returned normal range were 23.3 % ,60.5 % （P〈0.05）and 7l. 1% （P〈0.01）. The shrinkage of tumor volumes（〉50 % ） demonstrated as 8.3%,31.5%（P〈0.05）and 50.9%（P〈0.01） respectively. Univariate analysis identified 14 parameters including HBV DNA of prognostic significance. Multivariate analysis showed that Child-pugh classification, ICGR15, portal cancerous thrombi, interventional modes and decrease in AFP concentration after treatment were significant factors with evaluated prognosis. Conclusion The multi-interventional modes therapy give better results for HCC with decompensate cirrhosis, and for the patients with positive HBV DNA antivirus（hepatitis B） treatment are recommended.

关 键 词：失代偿性肝硬化 肝细胞癌 多模式介入治疗 预后 

分 类 号：R735.7[医药卫生—肿瘤] R575.2[医药卫生—临床医学]