用无水酒精碘化油乳剂超选择肝动脉栓塞治疗中晚期肝癌的研究  

Superselective transarterial ethonal embolization with ethanol-lipiodol mixture for advanced hepatocellular carcinoma

作　　者：黄德佳[1] 马亦龙[2] 康平[2] 李志坤[2] 欧盛秋[2] 赵昌[2] 

机构地区：[1]广西中医学院第一附属医院介入治疗中心 [2]广西医科大学肿瘤医院介入治疗科,南宁530021

出　　处：《中国癌症防治杂志》2009年第4期318-321,共4页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：广西科学研究与技术开发计划项目(桂科攻0632007-1j)

摘　　要：目的探讨经肝动脉无水酒精碘化油乳剂栓塞(Transarterial ethanol ablation with ethanol-lipiodol mixture,TEA)治疗中晚期肝癌的临床效果及其毒副反应。方法20例中晚期肝癌患者行超选择性肝动脉无水酒精碘化油乳剂栓塞治疗;20例行常规化疗栓塞。两组病例在肿瘤大小、部位、临床分期、肝功能、是否合并肝硬化及治疗次数等方面差异无统计学意义(P>0.05)。比较两组肿瘤坏死率、近期疗效、生存期及毒副反应。结果TEA治疗后肝癌的完全坏死和大部分坏死分别为4、14例,而常规组则相应为0、9例,两组比较差异有统计学意义(P=0.001)。TEA组1、2年累计生存率及有效率分别为90%、60%和55%;常规组则相应为70%、35%和30%,两组比较差异有统计学意义(P<0.05)。介入治疗后发热、腹痛及恶心呕吐等两组无差别,而在骨髓抑制方面,TEA组1例出现I度骨髓抑制,而TACE组有10例出现I度骨髓抑制,两组比较差异有统计学意义(P=0.005)。结论用无水酒精碘化油乳剂行超选择性肝动脉栓塞治疗对肝癌病灶杀伤性强,骨髓抑制发生率低,疗效明显优于常规化疗栓塞。Objective To evaluate the treatment effect of transarterial ethonal embolization with ethanol-lipiedol mixture for hepatocellular carcinomas （HCC） and its side effects, compared to conventional chemoembolization. Methods A case-eontrolhd study was undertaken with 20 patients in each group, matched on tumor characteristics, Child-Pugh grade, performance status and the times of treatment. The experimental group was treated with transarterial ethanol ablation with the ethanol-lipiedol mixture in a ratio of 1 ： 1, and the control group was treated with chemoembolization. The side effects of the therapy were recorded after operation. The effectiveness of the two treatments were evaluated by the parameters such as tumor necrosis, tumor response, disease progression, survival rate and overall survival. Result In the TEA group,4 patients achieved complete tumor necrosis, 14 patients showed the tumor necrosis area 〉 60%. While in the matched controls,there were none complete tumor necrosis and 9 patients had tumor necrosis 〉 60% （P = 0. 001 ）. the side effects such as fever, stomachache and vomit caused by arterial embolization between the two groups were not different （ P 〉 0. 05 ）. The incidence rate of bone marrow depression was higher in the control group （P 〈0. 05）. The median survival in TEA group was 26 months,while it was 21 months in TACE group. The accumulative survival rate of I year,2 years and the response rate （CR ＋ PR） were 90%, 60% and 55% respectively in TEA group, while were 70% ,35% and 30% respectively in TACE group, the total survival with the long-rank test was significantly different between the two groups. Conclusion Superselective transarterial ethonal embolization with ethanol-lipiodol mixture possesses markedly stronger anticaneerous effect and lower incidence rate of bone marrow depression, and its long-term effectiveness is superior to conventional TACE.

关 键 词：肝癌 肝动脉 栓塞治疗 

分 类 号：R735.7[医药卫生—肿瘤]