经动脉化疗栓塞与经动脉灌注化疗序贯栓塞治疗肝癌对比分析  

Long-term efficacy of transarterial chemoembolization and transarterial infusion chemotherapy followed by transarterial lipiodol embolization in patients with hepatocellular carcinoma:A comparative analysis

作　　者：高钦宗 李槐[1] 闫东[1] 姚雪松[1] 赵彦清[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院介入治疗科,北京100021

出　　处：《中国介入影像与治疗学》2015年第6期327-331,共5页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的评价TACE与经动脉灌注化疗序贯栓塞(TAI+TAE)治疗不可切除肝细胞癌(HCC)所致急性肝功能损伤及远期疗效的差异。方法回顾性分析195例接受动脉血管介入治疗患者的临床及介入治疗资料;其中TACE组111例,共接受介入治疗277例次,TAI+TAE组84例,共接受介入治疗250例次。结果两组间患者性别、年龄、合并肝炎、病灶类型、远处转移、门静脉癌栓、基线腹腔积液、介入治疗前肝功能Child-Pugh分级及血清甲胎蛋白(AFP)差异均无统计学意义(P均>0.05)。介入治疗前,TACE组与TAI+TAE组肝功能生化指标[血清谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、前白蛋白(PALB)、白蛋白(ALB)]差异均无统计学意义(P均>0.05)。两组患者介入治疗后ALT、AST、TBIL均较治疗前明显升高(P均<0.001),PALB、ALB明显减低(P均<0.001)。介入治疗前后肝功能生化指标变化值(ΔALT、ΔAST、ΔTBIL、ΔPALB、ΔALB)中,ΔALT、ΔAST、ΔPALB两组间差异有统计学意义(P均<0.05),ΔTBIL、ΔALB两组间差异无统计学意义(P均>0.05)。TACE组患者1、2、3年累积生存率(53.20%、33.30%、23.40%)高于TAI+TAE组(42.90%、22.60%、16.70%),差异有统计学意义(P=0.048)。结论 TACE较TAI+TAE所致急性肝功能损伤程度轻微,患者生存期更长,更有利于延缓肝硬化进展,改善远期疗效。Objective To evaluate the long-term efficacy and acute liver dysfunction caused by TACE and transarterial lipiodol embolization （TAI＋TAE） in treating non-removable hepatocellular carcinoma （HCC）. Methods A retrospective analysis of 195 patients who underwent transarterial interventional therapy was performed. The clinical and interventional treatment data were studied. According to the method of intervention, 195 patients were divided into TACE group （n= 111, interventional treatment for 277 times） and TAI＋TAE group （n=84, interventional treatment for 250 times）. Results There were no statistical differ- ences of gender, age, accompanying hepatitis, type of the lesion, distant metastasis, portal venous emboli, ascites, Child-pugh grade before interventional therapy and serum alpha-fetoprotein （AFP） between the two groups （all P〉0. 05）. And no statistical difference was found in liver function biochemical indexes, including alanine transaminase （ALT）, aspartate aminotransferase （AST）, total bilrubin （TBIL）, prealbumin （PALB） and albumin （ALB） between TACE and TAIWTAE groups （all P〉0. 05）. After interventional therapy, the ALT, AST, TBIL in both of the two groups were significantly higher than those detected before therapy （all P〈0. 001）. Moreover PALB and ALB were significantly decreased （both P〈0. 001）. The differences of liver func- tion biochemical indexes before and after interventional therapy included △ALT, △AST, △TBIL, △PALB and △ALB. There were statistical differences of AALT, AAST and AP.ALB between the wao groups （all P〈0. 05）. And no statistical difference was found in ATBIL and AALB （both P〉0.05）. The 1-, 2- and 3- year cumulative survival rates of TACE group （53. 20%, 33.30%, 23. 40%） were significantly higher than those of TAI ＋ TAE group （42. 90%, 22. 60%, 16.70%, P = 0. 048）. Conclusion The acute liver function damage caused by TACE is milder. TACE is helpful to delay the progress of liver cirrhosis

关 键 词：癌 肝细胞 化学栓塞 治疗性 急性肝功能损伤 总生存期 

分 类 号：R735.7[医药卫生—肿瘤] R817[医药卫生—临床医学]