肝动脉灌注化疗联合热疗治疗肝门部胆管癌的临床价值  

Clinical Evaluation of Hepatic Arterial Infusion Chemotherapy Combined with Hyperthermia for Hilar Cholangiocarcinoma

作　　者：陈耀庭[1] 姚和瑞[2] 孙宏亮[1] 骆江红[1] 江雄鹰[1] 陈栋[1] 许林锋[1] 

机构地区：[1]中山大学孙逸仙纪念医院介入放射科,广东广州510120 [2]中山大学孙逸仙纪念医院肿瘤科,广东广州510120

出　　处：《中山大学学报（医学科学版）》2014年第4期539-544,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省医学科研基金(A2011179)

摘　　要：[目的]初步评价肝动脉灌注化疗联合局部内生场热疗（热化疗）在肝门部胆管癌治疗的临床应用价值.[方法]对2003年10月至2013年6月期间39例接受介入治疗的肝门部胆管癌病人进行回顾性研究,其中热化疗组20例,于肝动脉置管,灌注吉西他滨后,再行肝动脉持续灌注卡铂及肿瘤区域内生场热疗60 min,热化疗后连续肝动脉灌注5-Fu 3 d,第8天静脉应用吉西他滨1次.对照组19例,肝动脉置管及化疗方案同前,未行热疗.上述治疗每4周为1疗程.化疗期间观察化疗毒副反应、并发症及耐受性,随访期间的疗效评价以无肿瘤进展生存时间（PFS）和生存时间（OS）为主要参考指标,并对两组的生存数据进行生存评估.[结果]热化疗组共行107个疗程治疗,OS为7.2～85.8个月,中位OS为23.7个月,PFS为7.2～80.3个月,中位PFS为20.3个月.对照组共行100个疗程治疗,OS为6.0～22.3个月,中位OS为17.5个月,PFS为3.5～19.5个月,中位PFS为14.2个月.经Log-rank检验显示热化疗在延长患者OS和PFS与对照组的治疗有统计学差异（P＜0.05）.治疗期间两组均无严重的化疗毒副反应和并发症.[结论]肝动脉灌注化疗联合内生场热疗在治疗肝门部胆管癌具有安全、微创、耐受性良好的特点,有望成为一个新的辅助性治疗.[Objective]To evaluate the clinical application of hepatic arterial infusion （HAI） chemotherapy combined with endogenetic field tumor hyperthermia （EFTH） in patients with hilar cholangiocarcinoma （HC）.[Methods]Between October 2003 and June 2013,medical records of 39 patients with HC who underwent interventional therapies were reviewed,retrospectively.Thermochemotherapy group （20 patients） was first treated with HA1 using Gemcitabine （0.8 g/m2）,and then carboplatin （0.25 g/m2）was continuously intraarterial （IA） infused with hilar region EFTH of 60 minutes.After thermochemotherapy,5-Fu （0.3 g/m2） was IA administered via catheter on Days 1-3.The same dose of Gemcitabine was administered intravenously （Ⅳ） on Day 8.Control group （19 patients） received the same dose and pathway management of chemotherapy without EFTH.Treatment cycle was repeated every 4 weeks.The curative effects,such as side-effects of chemotherapy,tumor-progression free survival （PFS） and overall survival time （OS）,were observed during follow-up.Survival data were analyzed between two groups.[Results]Follow-up ranged from 6.0 to 85.8 months.The thermochemotherapy group underwent 107 courses of the therapeutic combination.The median OS and median PFS were 23.7 months （ranging from 7.2 to 85.8 months） and 20.3 months （ranging from 7.2 to 80.3 months）,respectively.Compared with the thermochemotherapy group,the control group underwent 100 courses totally,and the median OS and median PFS were 17.5 months （ranging from 6.0 to 22.3 months） and 14.2 months （ranging from 3.5 to 19.5 months）,respectively.There were significant differences in OS and PFS between the two groups （P 〈 0.05）.There were no relevant severe side-effects and complications of the treatment and follow-up in two groups.[Conclusion]HAI chemotherapy combined with EFTH is safe,minimally invasive,more tolerant,and may be a neoadjuvant therapy for unresectable HC.

关 键 词：胆管癌 肝门 化疗 肝动脉 热疗 内生场 治疗 新辅助性 

分 类 号：R735.8[医药卫生—肿瘤]