肝癌切除术前经肝动脉化疗栓塞的疗效评价  

The effect of preoperative transarterial chemoembolization on hepatectomy of hepatocellular carcinoma

作　　者：林继宗[1] 涂旭升[1] 凌云彪[1] 吴飞龙[1] 陈署贤[1] 许瑞云[1] 

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630

出　　处：《中华普通外科杂志》2015年第10期777-780,共4页Chinese Journal of General Surgery

基　　金：广东省科技计划基金资助项目（2012A020602002）

摘　　要：目的探讨术前行经肝动脉化疗栓塞（transcatheter arterial chemoembolization，TACE）对肝癌切除术中及术后的影响。方法回顾分析原发性肝癌行肝癌切除（A组）和行一次TACE再行肝癌切除（B组）的患者资料。结果B组患者TACE后肿瘤体积较术前缩小，差异有统计学意义（t=3．31，P=0．021），肿瘤周围可见假包膜形成，肿瘤周围卫星灶显示清晰。A组患者肿瘤无包膜，边界难定。2组患者术中出血量比较差异无统计学意义（t=1．21，P=0．067），B组手术时间较A组长，差异有统计学意义（t=2．71，P=0．046）。B组胸腔积液发生率高于A组，差异有统计学意义（x^2=3．51，P=0．039）。2组患者并发症总体发生率比较差异无统计学意义（x^2=2．016，P=0．183）。A组切缘复发率高于B组，差异有统计学意义（x^2=3．85，P=0．031），肝内远处复发率高于B组，差异有统计学意义（x^2=2．76，P=0．046）。从第2年起B组的总生存率高于A组，差异有统计学意义（x^2=3．37，P=0．043），2组患者的1、2、3年无瘤生存率比较差异无统计学意义（x^2=0．06，P=0．965）。结论术前TACE能使肿瘤缩小，减少切缘复发及肝内远处转移，提高生存率。Objective To evaluate the effect of preoperative transarterial chemoembolization （TACE） for resectable hepatocellular carcinoma （HCC）. Methods HCC patients undergoing up-front hepatectomy （ group A） were compared with those receiving TACE before hepatectomy （ group B）. Results Tumor size decreased significantly after TACE （ t = 3.31 ,P =0. 021 ） . The rates of tumor encapsulation and liver adhesions were significantly more often seen in group B. There were fewer tumor-residual and more frequent necrosis in group B . Operative time in group B was longer （t = 2. 71, P = 0. 046 ）. The average blood loss and complication rate were of no difference between the two groups. The occurrence of pleural effusion and intrahepatic recurrence rate in group A was higher than group B （x^2 =3.85 ,P =0. 031 ） （x^2 = 2. 76,P =0. 046）. The overall survival rate from the second year postoperative in group B was higher than group A （x^2 = 3.37, P = 0. 043 ）. Conclusions TACE could diminish tumor, advance encapsulation and reduce tumor-residual. Preoperative TACE does not improve 1-, 2-, and 3-year tumor-free survival rates but improve 1-, 2-, and 3-year overall survival rates.

关 键 词：肝肿瘤 肝切除术 化学栓塞 治疗性 

分 类 号：R735.7[医药卫生—肿瘤]