微波固化术结合肝动脉、门静脉双化疗对中晚期肝细胞癌治疗的临床研究  

Clinical research of percutaneous microwave coagulation therapy with transcatheter arterial chemoembolization and portal vein chemotherapy on advanced liver cancer

作　　者：杜锡林[1] 宋暖[1] 杨涛[1] 陈安[1] 王成果[1] 董瑞[1] 杨媛[1] 臧莉[1] 鲁建国[1] 

机构地区：[1]第四军医大学唐都医院普通外科,陕西西安710038

出　　处：《生物医学工程与临床》2011年第6期526-529,共4页Biomedical Engineering and Clinical Medicine

基　　金：陕西省攻关课题(2008K14-02)

摘　　要：目的探讨经皮微波固化术(PMCT)结合经导管肝动脉、门静脉双化学治疗(简称化疗)中晚期肝细胞癌的临床疗效及安全性。方法选取2005年6月～2008年12月第四军医大学唐都医院普通外科收治的136例中晚期肝细胞癌患者,其中男性89例,女性47例;年龄17～82岁,中位年龄62.3岁。随机分为PMCT微创治疗组(A组,49例)、PMCT微创治疗结合肝动脉介入栓塞治疗组(B组,41例)、PMCT微创治疗结合肝动脉和门静脉双化疗组(C组,46例)。通过随访,收集患者一般资料,并对各组总存活率、肿瘤变化情况、门静脉栓子变化情况、术前、术后甲胎蛋白(AFP)变化及术后患者生活质量进行分析。结果 C组患者术后6个月、12个月、24个月存活率(95.65%、86.96%、76.09%)明显高于A组(91.84%、79.59%、59.18%)和B组(92.68%、78.05%、56.10%)。12个月后C组病灶完全缓解(CR)2.17%(1/46),部分缓解(PR)34.78%(16/46),总有效率为36.96%。术后AFP值(132 ng/mL)明显低于A组和B组(213 ng/mL和324 ng/mL)。门静脉栓子明显减小或消失(术前4.6 cm,术后2.7 cm)。患者治疗后腹痛、腹胀症状减轻,生活质量明显提高。治疗后并发症少,未出现与治疗有关的死亡。结论 PMCT微创治疗结合肝动脉、门静脉双化疗对中晚期肝细胞癌治疗效果确切,是一种安全、有效的治疗方法。Objective To explore the security and effect of percutaneous microwave coagulation therapy（PMCT） with transcatheter arterial chemoembolization（TACE） and portal vein chemotherapy on the treatment of advanced liver cancer.Methods A total of 136 advanced liver cancer patients were enrolled,male 89,female 47,aged 17-82 years old,median age 62.3 years old.They were randomly divided into 3 groups： PMCT（group A,49 cases）;PMCT with TACE（group B,41 cases）;PMCT with TACE and portal vein chemotherapy（group C,46 cases）.Followed-up all cases,collected general information,analyzed the overall survival,change of tumor,portal vein embolus,alpha-fetal protein（AFP） and postoperative quality of life.Results The survival of 6 months,12 months,24 months in group C（95.65 %,86.96 %,76.09 %） were obviously higher than group A（91.84 %,79.59 %,59.18 %） and group B（92.68 %,78.05 %,56.10 %）.For group C,the complete remission（CR） after 12 months was 2.17 %（1/46） and partial remission（PR） 34.78 %（16/46）,with the total effective 36.96 %.Compared with those in group A and B,patients in group C also had improved the quality of life after the treatment.AFP in group C（132 ng/mL） was significantly lower than that of group A（213 ng/mL） and group B（324 ng/mL）.Portal vein embolus were obviously reduced or disappeared（4.6 cm before treatment,2.7 cm after treatment）.Fewer complications and have no death after the treatment.Conclusion It is demonstrated that PMCT with TACE and portal vein chemotherapy is a security and effective process,it is curative effect in the treatment of advanced liver cancer.

关 键 词：肝细胞癌 经皮微波固化术 肝动脉化学治疗 门静脉化学治疗 生活质量 

分 类 号：R735.7[医药卫生—肿瘤]