联合微球和碘化油化疗栓塞治疗巨块型肝细胞癌的疗效评价  

Evaluation of therapeutic effects with microspheres embolization for giant hepatocellular carcinoma

作　　者：翁志成[1] 杨维竹[2] 

机构地区：[1]福建省莆田学院附属医院影像科,351100 [2]福建医科大学附属协和医院介入科,福州350001

出　　处：《中华放射学杂志》2011年第3期274-278,共5页Chinese Journal of Radiology

摘　　要：目的探讨经导管微球加碘化油化疗栓塞治疗巨块型肝细胞癌（HCE）的临床疗效。方法对156例确诊的巨块型HCC患者，按随机数字表法分成M、L、M＋L3组，每组52例。M组选用微球进行栓塞至肿瘤血管血流基本截断。L组单纯选用超液态碘化油栓塞。M＋L组先用总量1／3～1／2的碘化油栓塞，然后选用微球栓塞至肿瘤血管不显影。对比3组患者对栓塞的反应、肝功能和血清甲胎蛋白（AFP）变化、有效率（病灶完全消失＋病灶缩小的比例）、获益率（病灶完全}肖失＋病灶缩小＋病灶稳定的比例）、180d及360d生存率以及是否有栓塞并发症等，以探讨疗效。计数资料采用X2检验，计量资料采用方差分析。结果M组总有效率为38．5％（20／52），获益率为73．1％（38／52），180d及360d生存率分别为88．5％（46／52）、82．3％（43／52）；L组总有效率为42．3％（22／52），获益率为76．9％（40／52），180d及360d生存率分别为86．5％（45／52）、75．0％（39／52）；M＋L组总有效率为55．8％（29／52），获益率为88．5％（46／52），180d及360d生存率分别为94．2％（49／52）、86．5％（45／52）。采用X2检验比较，M＋L组与M组、L组的有效率及获益率差异有统计学意义（X2值分别为6．27、6．16，P值均〈0．05）。同时，术后M组、L组与M＋L组的发热发生率分别为63．4％（33／52）、86．5％（45／52）、69．2％（36／52）、恶心呕吐发生率分别为67．3％（35／52）、84．6％（44／52）、76．9％（40／52）、肝区疼痛发生率分别为59．6％（31／52）、86．5％（45／52）、73．1％（38／52），采用）（。检验比较差异也有统计学意义（X2值分别为6．55、6．22、6．90，P值均〈0．05）。结论微球＋碘化油联合栓塞治疗原发性巨块型HCC较单独使用碘化油或微球栓塞更有效，且不良反应发生率低。Objective To evaluate the clinical therapeutic effect with microspheres embolization for giant hepatocellular carcinoma（HCC）. Methods A prospective study was performed for 156 HCC patients needed for TACE, then randomly signed them into group M （ embolized by microspheres alone ） , group L （ embolized by lipiodol alone） and group M ＋ L （ embolized by mierospheres combined with lipiodol）. TACE of group M was performed by 300--700 μm microspheres. Group L selected lipiodol alone to embolize. While group M ＋ L were embolized by about 1/3--1/2 lipiodol of total embolized volume and then microspheres feeding individual tumor vessels. Stoped the procedure when caused terminal vessel blockade. Before and after therapy, patients＇liver function, serum α-fetoprotein level （AFP）, responses of tumor, complications related to embolization and survive rates of 180 days and 360 days were analyzed among three groups. Enumeration data such as survive rates and positive response were compared by X2 test,while measurement data were analyzed by one-way classification. Results The positive response （ CR ＋ PR ） of group M was 38.5 % （20/52）and （ CR ＋ PR ＋ SD）73.1% （38/52）. Survive rates of 180 days and 360 days were 88.5 % （46/52） and 82. 3% （43/52）. While those of group L were 42.3% （22/52）,76.9% （40/52）,86.5% （45/52）, 75.0% （ 39/52 ） and group M ＋ L were 55.8% （ 29/52 ）, 88.5% （46/52）, 94. 2% （ 49/52 ）,86. 5% （45/52）. Significant difference of survival rates and total effective between group M ＋ L and M, M ＋ L and L was found （ X2 = 6.27,6. 16, P 〈 0. 05）. At the same time adverse responses of incidence and persis time such as febricity, nausea and vomit, hepatic pain were more lower in group M ＋ L and group M. Three groups febrieity rate were 63.4% （33/52） ,86.5% （45/52） and 69.2% （36/52）, nausea and vomit were 67.3% （35/52） ,84. 6% （44/52） and 76. 9% （40/52）, hepatic pain were 59.6% （31/52） ,86. 5% �

关 键 词：癌 肝细胞 微球体 碘化油 栓塞 治疗性 治疗结果 

分 类 号：R735.7[医药卫生—肿瘤]