肝动脉化疗栓塞联合FOLFOX方案动脉留管灌注治疗BCLC-B期原发性肝癌疗效观察  

Transarterial chemoembolization and arterial infusion chemotherapy with FOLFOX regimen through indwelling catheter for Barcelona Clinic Liver Cancer Stage B hepatocellular carcinoma

作　　者：王振军[1,2] 黎海亮[1,2] 郭晨阳[1,2] 郑琳[1,2] 王鹏[3] 

机构地区：[1]郑州大学附属肿瘤医院 [2]河南省肿瘤医院放射介入科,郑州450008 [3]郑州大学临床医学系,2012级郑州450052

出　　处：《中华实用诊断与治疗杂志》2015年第10期1031-1033,共3页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 探讨肝动脉化疗栓塞（transarterial chemoembolization,TACE）联合FOLFOX方案（奥沙利铂＋亚叶酸钙＋脱氧氟尿苷）动脉留管灌注治疗巴塞罗那临床肝癌分期B期（Barcelona Clinic Liver Cancer Stage B,BCLC-B）原发性肝癌的近期疗效和安全性。方法 62例BCLC-B期原发性肝癌患者依据治疗方法分为观察组29例和对照组33例,对照组应用奥沙利铂100mg＋脱氧氟尿苷1 000mg动脉灌注15min后,应用奥沙利铂50mg＋超液化碘油行TACE治疗;观察组应用脱氧氟尿苷1 000mg动脉灌注15min,应用奥沙利铂50mg＋超液化碘油行TACE治疗,之后静脉滴注亚叶酸钙300mg,完毕后序贯泵入奥沙利铂100mg（时间2h）,脱氧氟尿苷2 000mg（时间44h）,泵入脱氧氟尿苷前静脉滴注亚叶酸钙300 mg。2组均每4周治疗1次,连续治疗4次后评价近期疗效,观察谷丙转氨酶（glutamic-pyruvic transaminase,GPT）、谷草转氨酶（glutamic-oxaloacetic transaminase,GOT）、总胆红素（total bilirubin,TBil）及直接胆红素（direct bilirubin,DBil）水平变化,记录不良反应发生情况。结果 观察组近期有效率（79.31%）、临床获益率（93.11%）均高于对照组（54.55%,72.73%）（P〈0.05）;对照组、观察组治疗后GPT[（53.8±1.5）、（54.5±2.2）u/L]、GOT[（65.2±2.7）、（66.4±3.6）u/L]、TBil[（20.7±1.1）、（21.1±0.8）μmol/L]及DBil[（8.1±0.8）、（7.6±1.3）μmol/L]均较治疗前[GPT：（47.5±3.9）、（46.9±2.5）u/L,GOT：（41.6±2.7）、（42.9±3.5）u/L,TBil：（18.7±1.9）、（19.5±1.2）μmol/L,DBil：（6.1±0.7）、（5.7±0.7）μmol/L]增高,差异有统计学意义（P〈0.05）;2组治疗后各指标比较差异无统计学意义（P〉0.05）;观察组Ⅰ~Ⅱ度恶心呕吐发生率（37.93%）及Ⅰ度骨髓抑制发生率（75.86%）与对照组（39.39%,72.73%）比较差异无统计学意义（P〉0.05）。结论 TACE联合FOLFOX方案留管动脉灌注治疗BCLC-B期原发性肝癌的疗效优于TAObjective To assess the short-term therapeutic effect and safety of transarterial chemoembolization （TACE） and arterial infusion chemotherapy with FOLFOX regimen （oxaliplatin, calcium folinate and floxuridine） through indwelling catheter in the treatment for Barcelona Clinic Liver Cancer Stage B （BCLC B） hepatocellular carcinoma （HCC）. Methods Sixty-two patients with HCC were divided into observation group （n= 29） and control group （n= 33）. Control group received arterial infusion with oxaliplatin 100 mg ＋ floxuridine 1 000 mg in 15 minutes, followed by TACE treatment with oxaliplatin 50 mg and lipiodol. Observation group received arterial infusion with floxuridine 1 000 mg for 15 minutes, TACE treatment with oxaliplatin 50 mg and lipiodol. Calcium folinate 300 mg was given by intravenous drip, followed by continuous hepatic arterial infusion with oxaliplatin 100 mg for 2 hours and floxuridine 2 000 mg for 44 hours. Both two groups were treated once per 4 weeks as one cycle, totally for 4 cycles. After treatment, the short-term effect was evaluated. The levels of glutamic-pyruvic transaminase （GPT）, glutamic-oxaloacetic transaminase （GOT）, total bilirubin （TBil） and direct bilirubin （DBil） were observed and the adverse reactions were recorded. Results The short term effect and clinical benefit rates were higher in observation group （79.31 %, 93.11 %） than those in control group （54.55%, 72.73%） （P〈0.05）. The levels of GPT （（53.8± 1. 5）, （54.5±2.2） u/L）, GOT （（65.2±2.7）, （66.4±3.6） u/L）, TBil （（20.7±1.1）, （21. 1±0.8） μmol/L） and DBil （（8. 1±0.8）, （7.6± 1.3） μmol/L） in observation group and control group after treatment were significantly higher than those beforetreatment （GPT： （47. 5±3.9）, （46.9±2. 5） u/L; GOT： （41. 6±2. 7）, （42. 9±3. 5） u/L）; TBil： （18. 7±1. 9）, （19.5±1.2） μmol/L） ; DBil： （6.1±0.7）, （5.7±0.7） μmol/L） （P〈0.05）, and there w

关 键 词：原发性肝癌 肝动脉化疗栓塞 FOLFOX方案 留管灌注 

分 类 号：R735.7[医药卫生—肿瘤]