TACE治疗53例Child C级肝硬化并发小肝癌患者疗效评价  

Efficacy of TACE treatment in 53 patients with small hepatocellular carcinoma with underlying liver cirrhosis of Child-Pugh class C

作　　者：肖潇[1] 杨均[1] 颜綦先[1] 付鑫[1] 李宁[1] 魏艳玲[1] 周世亮[1] 彭安国[1] 张寅[1] 陈东风[1] 胡辂[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所消化内科,重庆市400042

出　　处：《实用肝脏病杂志》2016年第2期204-207,共4页Journal of Practical Hepatology

摘　　要：目的评价Child C级肝硬化并发小肝癌患者行经肝动脉栓塞化疗（TACE）治疗的疗效。方法回顾性分析2002年12月～2012年12月我科53例行TACE治疗的Child C级肝硬化并发小肝癌患者的临床资料。每例患者至少行2次TACE治疗,两次治疗间隔为30～40 d,以第2次TACE治疗结束时开始随访,所有病例均随访2年,于术后第1、3、6、12、24 m复查肝功能、AFP、凝血功能指标、腹部CT或MRI检查。结果术后1、3、6、12和24m总有效率分别为100.0%、100.0%、83.0%、54.7%、41.5%,其中1 a生存率约为60.0%,2 a生存率为45.0%;在TACE术后1 m,患者肝功能较术前变化无统计学差异,凝血功能指标变化较术前也无统计学差异[PT为（17.1±2.4）s对（16.7±2.2）s];在TACE术后24 m,血清ALT较术前下降,与治疗前比,有统计学差异[（89.4±21.2）U/L对（67.9±20.4）U/L,P〈0.05];死亡原因主要是基础肝病所致。结论 TACE治疗Child C级肝硬化并发小肝癌患者,临床有一定的疗效,能显著延缓这类患者因肝癌进展所致的死亡。Objective To evaluate the therapeutic efficacy of transcatheter arterial chemoembolization（TACE） in patients with small hepatocellular carcinoma and underlying liver cirrhosis of Child-Pugh class C.Methods Retrospective analysis of 53 patients with cirrhosis of Child-Pugh class C complicated by small hepatocellular carcinoma who had underwent TACE in our Department from December 2002 to December 2012 was conducted. Each patient received TACE for at least two times with an interval of 30 to 40 days,and was followed after the second TACE for 2 years. Liver function,serum AFP,coagulation function and abdominal CT scan or MRI scan were monitored at 1,3,6,12 and 24 months after the treatment. Results Effective rates of TACE in this series at 1,3,6,12 and 24 months after TACE were 100.0%,100.0%,83.0%,54.7%,41.5%,respectively;There was no significant differences in liver function and coagulation function between baseline and those at 1 month after TACE;However,serum ALT levels significantly declined at 24 months after the treatment[（67.9 ±20.4） U/L vs.（89.4 ±21.2） U/L,P〈0.05];And the major cause of death was fundamental liver disease.Conclusion The clinical efficacy TACE in patients with liver cirrhosis of Child-Pugh class C complicated by small hepatocellular carcinoma is reliable,and TACE markedly reduces death due to exacerbation of hepatocellular carcinoma.

关 键 词：小肝癌 肝硬化 经肝动脉栓塞化疗 CHILD分级 

分 类 号：R735.7[医药卫生—肿瘤] R575.2[医药卫生—临床医学]