肝动脉热灌注化疗栓塞联合射频消融治疗原发性肝癌的对照研究  

Comparative Study of Transhepatic Artery Interventional Thermochemotherapy and Embolism Combined with Radiofrequency Ablation in the Treatment for Hepatic Carcinoma

作　　者：郑琳[1,2] 郭晨阳[1,2] 黎海亮[1,2] 肖金成[1,2] 程洪涛[1,2] 胡鸿涛[1,2] 宗登伟[1,2] 

机构地区：[1]郑州大学附属肿瘤医院 [2]河南省肿瘤医院介入科,郑州450008

出　　处：《临床放射学杂志》2013年第7期1032-1035,共4页Journal of Clinical Radiology

基　　金：河南省科技厅科技重点攻关项目(编号:08210231002)

摘　　要：目的探讨经肝动脉热灌注化疗栓塞(TACE)联合射频消融(RFA)治疗原发性肝癌的价值。方法回顾性分析80例Ⅰ～Ⅱ期的原发性肝癌患者。A组(热灌注TACE联合RFA)36例,采用Seldinger法插管入肝内肿瘤供血动脉,将吉西他滨1000 mg溶于1200 ml生理盐水,以设定温度51℃,0.8～1.0 ml/s的流速进行热化疗灌注,然后用吉西他滨200 mg+卡铂200 mg+超液化碘油进行化疗栓塞。B组(热灌注TACE)44例,与A组相同方案行热灌注TACE。每4周为一周期,A组连续2周期后间隔2周,对原病灶行全麻下RFA治疗,B组连续4周期治疗。治疗后按mRECIST标准行影像评价有效率,比较卡氏评分、近期疗效、甲胎蛋白(AFP)转阴率、生存率、中位生存期。结果 A组卡氏评分改善、AFP转阴率、近期有效率均优于B组(Z=-2.080,P=0.038;P=0.037;Z=-6.756,P<0.001)。1、2、3年生存率:A组分别为97%、92%、78%,B组分别为80%、70%、36%;中位生存期:A组43个月,B组29个月,差异均有统计学意义(P<0.05)。结论热灌注TACE联合RFA可进一步提高原发性肝癌治疗效果。[ Abstract] Objective To assess the therapeutic effect of transhepatic artery interventional thermochemotherapy and em- bolism combined with radiofrequency ablation in treating hepatic carcinoma. Methods 80 cases with stage I - fl hepatic carcinoma were retrospectively analyzed. In group A （ thermochemotherapy and embolization ＋ RFA group, n = 36） , the catheter was inserted into the intrahepatic tumor feeding artery using seldinger technique with Gemcitabine 1000rag dis- solved in 1200 ml normal saline. The perfusion temperature 51 ~C and flow rate of 0.8 ~ 1.0 ml/s was set and thermoche- motherapy was given, then Gemcitabine 200mg ＋ Carboplatin 200mg ＋ lipiodol were used for chemoembolization treat- ment. In group B （ thermochemotherapy and embolization groups, n = 44）, the program for thermochemotherapy and emboli- zation was same to group A. The treatment was repeated once every four weeks as a cycle. After the completion of two cycles of treatment and then an interval of two weeks, RFA under general anesthesia was used to treat the primary lesions in group A. Consecutive four cycles of treatment were used in group B. After treatment, Efficiency was evaluated with images ac- cording to mRECIST standard. KPS, short term effect, AFP negative conversion rate, year survival rate, median survival time were compared between two groups. Results The KPS score improvement, AFP negative conversion rate and the o- verall response rate in Group A were better than those in group B. There were significant difference between the two groups （ P 〈 0.05 ）. In group A, the 1 ,2, 3 year Survival rate was 97 % ,92% , 78 % , median survival time （MST） was 43 months. In group B,the 1,2,3 year Survival rate was 80% , 70% , 36% ,median survival time（MST） was 29 months. There were significant difference between two groups （ P 〈 0.05 ）. Conclusion The treatment effect of hepatic carcinoma can be fur- ther improved by transhepatic artery interventional thermochemotherapy and embolism combined with radio

关 键 词：肝脏 原发性肝癌 热灌注 化疗 栓塞 射频消融 介入放射学 

分 类 号：R735.7[医药卫生—肿瘤]