综合介入治疗伴肝功能失代偿肝癌临床分析  

Study of treatment for hepatocellular carcinoma with decompensational hepatocirrhosis by multi-interventional therapeutic alliance

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

机构地区：[1]解放军第85医院南京军区肝病临床研究中心,上海200235

出　　处：《中华临床医师杂志（电子版）》2008年第10期25-28,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨伴失代偿性肝硬化肝癌综合介入治疗的临床价值。方法57例伴肝功能失代偿肝癌患者在内科治疗稳定后接受肝动脉节段性化学栓塞治疗(S-TACE),并在1～2周后序贯射频消融(RFA)或加无水乙醇局部注射(PEI)治疗。结果45例甲胎蛋白(AFP)升高患者于术后2～4周开始下降,32例(71.11%)逐渐达到正常;3个月后肿瘤缩小50%以上者为59.65%(34/57);中位生存期13.7个月,6个月、12个月和24个月累计生存率分别为:75.44%(43/57)、40.35%(23/57)和19.30%(11/57);变量Cox模型分析显示包括HBV DNA在内的14项因素与预后显著相关,多因素Cox模型分析显示靛氰绿15min排泄试验(ICGR15)、门静脉癌栓、治疗次数及AFP术前升高者介入后变化与预后显著相关。结论综合介入治疗是伴肝功能失代偿肝癌的有效治疗方法,对HBV DNA阳性患者应该考虑抗HBV治疗。Objective To evaluate the efficiency of muhi-interventional therapeutic alliance in treating primary hepatocellular carcinoma with decompensational liver cirrhosis. Methods Fifty-seven cases of hepatocellular carcinoma were performed with segmental transcatheter arterial chemo-embolization （ S- TACE） and radiofrequency ablation （RFA） or added on percutaneous ethanol injection （PEI）. Univariate and multivariate Cox proportional hazard regression model were used to analyze the factors affecting the prognosis. Results All patients had been followed up for 3 months to 50 months. The median survival time was 13.7 months. The overall cumulative survival rates for 6,12 and 24 months were 75.44 % （43/57）, 40. 35% （ 23/57 ） and 19.30% （ 11/57 ） respectively. Univariate analysis identified 14 parameters （ include HBV DNA） of prognostic significance. Multivariate analysis showed that ICGR15,portal cancerous thrombus, times of treatment and decrease in AFP concentration after treatment were significant factors. Conclusions The multi-interventional therapeutic alliance give better results for hepatocellular carcinoma with decompensational hepatocirrhosis, and the patient with positive HBV DNA should be recommended antivirus （hepatitis B） treatment.

关 键 词：肝硬化 肝肿瘤 放射学 介入性 综合疗法 

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