121例原发性肝癌治疗结果分析  

Analysis on Treatment Results of 121 Patients with Primary Liver Carcinoma

作　　者：冀振华[1] 张志成[1] 白钢[1] 杨英祥[1] 夏念信[1] 邱宝安[1] 马元桂[1] 

机构地区：[1]海军总医院肝胆外科,北京100037

出　　处：《海军总医院学报》2002年第2期85-88,共4页Journal of Naval General Hospital of PLA

摘　　要：目的　分析原发性肝癌不同治疗方法的效果 ,探讨最佳治疗方案。方法　回顾性分析 1991年 5月～ 1998年 5月间 12 1例原发性肝癌患者 ,早期 34例 (Ⅰ期 2例 ,Ⅱ期 32例 ) ,中晚期 87例 (Ⅲ期 3例 ,Ⅳa期 84例 )。按不同治疗方法各分成 4组 :(1)保守治疗组 :仅行口服化疗药物或中医中药及保肝支持治疗 ;(2 )化疗组 :经股动脉行肝动脉插管栓塞化疗或手术置化疗泵栓塞化疗 ,化疗次数 1～ 7次 ;(3)手术切除组 :仅行肿瘤的病灶切除或肝叶切除 ;(4)手术切除 +化疗组 :在手术切除肿瘤前或后行经股动脉插管栓塞 化疗或术中肝动脉和 或门静脉置化疗泵 ,术后行栓塞 化疗。 87例中晚期肝癌中 2 4例并发门脉癌栓 ,4 2例直径≥ 10cm ,4 5例直径 <10cm ,分别分成 3组 :保守组、化疗组及手术切除或 +化疗组。结果　 34例早期肝癌和 87例中晚期肝癌的中位生存时间分别为 2 4 0月和 7 0月 ,其 1、2、3年的生存率分别为 :6 7 6 %、5 5 9%、4 4 1%和 2 7 6 %、9 2 %、5 7%。 5 7例行化疗和 2 4例并发门脉癌栓的中晚期肝癌中位生存时间为 6 0月和 5 0月 ,其 1、2、3年的生存率分别为 :2 8 1%、10 5 %、7 0 %和 12 5 %、4 2 %、0。 4 2例直径≥ 10cm和 4 5例直径 <10cm的中晚期肝癌中位生存时间为 6 5月和 8 0月 ,?Objective To find the best protocol from analyzing therapeutic effect and significance of different methods for primary liver carcinoma.Methods 121 patients with primary liver carcinoma treated in 1991.5～1998.5 were divided into 4 groups: Conservative treatment group (A): only treated by oral chemotherapy, Chinese traditional medicine and hepatic function support; Chemoembolization group (B): taking 1～7 times hepatic arterial chemoembolization (HACE); Hepatic resection group (C): taking hepatic segmentectomy or lobectomy; Hepatic resection+chemotherapy group (D): taking HACE or portal vein infusion (PVI) or hepatic artery infusion (HAI) before or after hepatic segmentectomy or lobectomy. 57 patients treated by HACE were also divided into 4 groups: One time HACE (B 1); Two times HACE(B 2); Over three times HACE(B 3); HACE+other methods(B 4).Results The median survival period of 37 cases with early stage primary liver carcinoma was 24.0 months. Their survival rates in 1 ,2 and 3 year was 67.6%, 55.9%, 44.1% respectively. The median survival period of 87 cases with advanced primary liver carcinoma was 2.5, 8.0, 7.0 and 10.0 months in group A, B, C, D respectively. Their survival rates in 1 , 2 and 3 year was 8.3%, 0, 0 in group A; 28.1%, 10.5%, 7.0% in group B; 25.0%, 12.5%, 0 in group C; 50.0%, 10.0%, 10.0% in group D respectively. The survival rates differed significantly between 4 groups. Their survival rates in 1 , 2 and 3 year of 57cases treated by HACE was: 0, 0, 0 in group B 1; 37.5%, 12.5% 6.3% in group B 2; 35.5%, 11.8%, 5.9% in group B 3; 28.6%, 14.3%, 14.3% in group B 4 respectively. The survival rates differed significantly between B 1 and B 2, B 3, B 4. The survival rate in 3 year differed significantly between B 4 and B 1, B 2, B 3. Conclusion Surgical resection combined with local hepatic chemotherapy or chemoembolization significantly improves the curative effect and life quality of the patient with primary liver carcinoma. The best protocol of HACE is 2～3 times

关 键 词：肝肿瘤 治疗 肝切除 化学栓塞 生存率 

分 类 号：R735.7[医药卫生—肿瘤]