术中局部植入氟尿嘧啶缓释剂治疗原发性肝细胞癌  

Intraoperative implanting slow-released 5-flourouracil in hepatocellular carcinoma patients undergoing hepatectomy

作　　者：陈元元[1] 梁中骁[1] 潘金飞[1] 

机构地区：[1]广西壮族自治区人民医院肝胆外科,南宁530021

出　　处：《中华普通外科杂志》2012年第2期107-110,共4页Chinese Journal of General Surgery

基　　金：广西医疗卫生重点科研课题基金资助项目（重200812）

摘　　要：目的探讨肝癌根治术中植入氟尿嘧啶缓释剂的安全性及其对无瘤生存率和总体生存率的影响。方法收集2008年1月至2009年1月完成肝癌根治手术的患者59例，按术中有无使用氟尿嘧啶缓释剂分为治疗组（24例）和对照组（35例），两组患者术后均未予其他化疗。检测两组患者术前1天、术后3周的白细胞、肝功能、AFP；术后半年内每月、半年后每3个月复查AFP及影像学，对可疑复发的患者行CT引导下穿刺活检确诊，统计术后6、12、18、24个月的无瘤生存率和总体生存率。结果术后3周治疗组WBC、ALT、AST、TBIL，与对照组差异无统计学意义（分别t=0．801、-0．854、-1．948、-0．503，均P〉0．05）。治疗组术前、术后3周、术后6个月AFP为（361．58±431．06）μg／L、（17．02±15．55）μg／L、（43．61±58．03）μg／L，对照组为（495．50±441．63）μg／L、（26．82±60．46）μg／L、（127．48±229．79）μg/L。术后6个月治疗组明显低于对照组（t=-2．065，P〈0．05）。治疗组术后6、12、18、24个月的无瘤生存率为95．8％、91．7％、79．2％、75．0％，对照组为94．3％、71．4％、60．0％、48．6％（Logrank检验x^2=4．035，P〈0．05）；治疗组术后6、12、18、24个月的总体生存率为100％、95．8％、91．7％、83．3％，对照组为100％、94．3％、77．1％、60．o％（Logrank检验x^2=3．931，P〈0．05）。结论术中植入氟尿嘧啶缓释剂具有良好的安全性，是降低肝癌复发率、延长患者生存期的有效方法。Objective To study the safety and efficacy of intraoperative implanting slow-released 5- Fu after hepatectomy in patients with hepatocellular carcinoma （HCC）. Methods 59 HCC patients undergoing hepatectomy from January 2008 to January 2009 were divided into two groups： to receive slow- relaesed 5-Fu in treatment group and nothing in control group. Postoperatively no patients in both group took chemotherapy. The serous value of WBC, ALT, AST, TBIL and AFP were measured in all cases on 1 day before and 3 weeks after the operation. During the first six months, AFP was measured and imaging studies were done one month after discharge, and every 3 months since then. CT-guided biopsy was used to confirm the recurrence of HCC. Disease-free survival rate and overall survival rate in two groups calculated respectively 6-, 12-, 18- and 24-months after the operation. Results The serous value of WBC, ALT, AST, TBIL was not different between treatment group and control group 3 weeks after the operation （separately t = 0. 801, - 0. 854, - 1. 948, - 0. 503,all P 〉 0.05）. AFP was （361.58± 431.06） μg/L, （17.02 ± 15.55） μg/L, （43.61 ± 58.03） μg/L in treatment group and （495.50± 441.63） μg/L, （26. 82±60. 46） μg/L, （127.48±229. 79） μg/L in control group preoperatively, 3 weeks and 6 months after the operation. AFP was lower in treatment group than that in control group （ t = - 2. 065, P 〈 0. 05 ）. The disease-free survival rate in treatment group was 95.8% , 91.7% , 79.2% , 75.0% at 6-,12-,18- and 24-months after the operation, in control group it was 94. 3%, 71.4%, 60. 0%, 48.6% （X^2 =4. 035 ,P 〈 0. 05）. The overall survival rate was respectively 100% , 95.8% , 91.7% , 83.3% in treatment group and was 100% ,94. 3% ,77.1% ,60.0% in control group（ X^2 = 3.931 ,P 〈0. 05）. Conclusions Intraoperative implanting slow-released 5-Fu during the hepatectomy was safe and effective method to reduce the recurrence rate of hepatocellular carcinoma and prolongs postoperative disease

关 键 词：癌 肝细胞 氟尿嘧啶 存活率 抗肿瘤联合化疗方案 

分 类 号：R735.7[医药卫生—肿瘤]