以手术为主的系列疗法治疗原发性大肝癌(附191例报告)  

A surgery oriented serial treatments of 191 patients with large primary liver cancer

作　　者：芮静安[1] 王少斌[1] 陈曙光[1] 周立[1] 魏学[1] 韩凯[1] 张宁[1] 赵海涛[1] 杨欣[1] 

机构地区：[1]邮电总医院肝癌研究所北京大学第八临床医学院肝脏外科,北京100032

出　　处：《中华肿瘤杂志》2001年第5期417-419,共3页Chinese Journal of Oncology

摘　　要：目的　探讨以手术为主的系列疗法治疗原发性大肝癌的方法及疗效。方法　手术治疗原发性大肝癌 191例 ,其中行各类肝切除术 12 1例 ,行深度冷冻治疗 70例。术中配合全植入式输药器(IDDS)植入 ,手术前后配合经导管肝动脉化疗栓塞术 (TACE)、无水酒精注射 (PEI)、生物免疫治疗和中医中药治疗。以CT动脉造影CTA)、动脉期CT门脉造影 (CTAP)作为早期发现卫星灶的方法 ,并以外周血AFPmRNA监测肿瘤的转移复发。术前肝功能评价采用Child分级配合BCAA/AAA。结果切除组 1,3,5年生存率分别为 75 .8%、45 .6 %和 30 .4%。冷冻组 1,3年生存率分别为 6 3.2 %和37.0 %。手术死亡率为 1.6 %。AFPmRNA阳性者复发率为 6 9.2 % ,阴性者复发率为 33.3% ,二者间差异有显著性 (P <0 .0 5 )。手术死亡者BCAA/AAA均 <1.5。结论　以手术为主的系列疗法对原发性大肝癌有良好疗效 ,应成为大肝癌治疗的主要策略。外周血AFPmRNA与肝癌复发有关 ,有望成为新的临床指标。BCAA/AAA加Child分级可更为准确地评价术前肝脏储备功能。Objective To discuss the methods and effects of a series of surgery oriented therapies in the treatment of large primary liver cancers. Methods From January 1993 to June 1999, 191 patients with large liver cancer were treated chiefly by operation. The size of the primary cancer varied from 5.2 to 19.7 cm (median 9.4 cm). Various kinds of liver resections were performed in 121 patients and, as a supplement, deep cryosurgery was carried for out the rest 70 patients. Importable drug delivery system (IDDS) was instituted intraoperatively. Transcatheter arterial chemo embolization (TACE, THP 30～60 mg, E ADM 20～40 mg, CDDP 40～80 mg, MMC 10～20 mg, iodine oil 5～30 ml), percutaneous ethanol injection (PEI), bioimmunotherapy and the traditional Chinese medicine were used pre and post operatively. CT angiography (CTA) and CT during arterial portography (CTAP) were used to find satellite nodules. Early recurrence was diagnosed by AFPmRNA monitor in peripheral blood. Child′s classification plus branch chain amino acid/aromatic amino acid (BCAA/AAA) were adopted in evaluating the pre operative liver functions.Results Remarkable results were observed after this surgery oriented serial treatment. The 1 , 3 and 5 year survival rates in the resection group were 75.8%, 45.6% and 30.4%, respectively. The 1 and 3 year survival rates in the cryosurgery group were 63.2% and 37.0%. The operative mortality was 1.6%. Recurrence rates were 69.2% in AFPmRNA positive group and 33.3% in AFPmRNA negative group. Comparing this two groups, significant difference was observed ( P <0.05). BCAA/AAA were lower than 1.5 in two patients died after resection.Conclusion A serial treatment with surgery as the chief modality gives satisfactory results in large primary liver cancers. This regimen should be adhered to as a main strategy in dealing with large liver cancers. AFPmRNA in the peripheral blood, signifying a recurrence, may become a hope of a new clinical parameter. BCAA/AAA plus Child′s classification is able

关 键 词：肝肿瘤 冷冻治疗 外科手术 全植入式输药器 免疫治疗 PEI TACE 

分 类 号：R735.7[医药卫生—肿瘤] R730.5[医药卫生—临床医学]