超声引导下经皮肝穿刺注射华蟾素与无水乙醇治疗门静脉癌栓的效果比较  

Effect of ultrasound- guided percutaneous injection of cinobufotalin or anhydrous ethanol in treatment of portal vein tumor thrombus: a comparative analysis

作　　者：冀建峰[1] 肖秋金[1] 邓晓莉[1] 

机构地区：[1]解放军第九四医院,南昌330002

出　　处：《临床肝胆病杂志》2016年第4期673-677,共5页Journal of Clinical Hepatology

基　　金：2013年江西省卫生厅中医药科研基金课题(2013A044)

摘　　要：目的对比观察超声引导下经皮肝穿刺注射华蟾素与注射无水乙醇治疗门静脉癌栓的疗效。方法选取2009年10月^(-2)011年12月解放军第九四医院收治的56例肝癌术后复发的门静脉癌栓患者,其中27例行超声引导下经皮肝穿刺华蟾素注射治疗(华蟾素组),29例行超声引导下经皮肝穿刺无水乙醇注射治疗(无水乙醇组)。对比2组患者的临床疗效及生存期,并比较其治疗前后的TBil、ALT、AST水平。计量资料组间比较采用t检验,计数资料组间比较采用χ~2检验,等级资料比较采用Mann-Whitney U检验,生存分析采用Kaplan-Meier法。结果华蟾素组治疗后的有效率为63.0%,无水乙醇组58.6%,2组差异无统计学意义(χ~2=0.111,P>0.05);华蟾素组治疗后的TBil、ALT和AST水平均低于无水乙醇组,差异均有统计学意义(t值分别为2.24、2.40、2.39,P值均<0.05);华蟾素组6个月、1、2年生存率分别为81.5%、63.0%、29.6%;无水乙醇组分别为82.8%、58.6%、31.0%,2组差异均无统计学意义(χ~2值分别为0.016、0.111、0.013,P值均>0.05)。结论超声介入注射华蟾素和注射无水乙醇治疗门静脉癌栓的近期疗效和远期疗效相似,均能起到抑制癌栓生长、延长生存期的作用,但华蟾素介入治疗在保护肝功能方面优于无水乙醇。To investigate the effect of ultrasound- guided percutaneous injection of cinobufotalin or anhydrous ethanol in the treatment of portal vein tumor thrombus（ PVTT） through a comparative analysis. Methods A total of 56 patients with PVTT after liver cancer surgery,who were admitted to the 94 th Hospital of PLA from October 2009 to December 2011,were enrolled. Among these patients,27 underwent ultrasound-guided percutaneous injection of cinobufotalin（ cinobufotalin group） and 29 underwent ultrasound- guided percutaneous injection of anhydrous ethanol（ anhydrous ethanol group）. The clinical outcome and survival time were compared between the two groups after treatment,and the levels of total bilirubin（ TBil）,alanine aminotransferase（ ALT）,and aspartate aminotransferase（ AST） before and after treatment were compared. The t- test was used for comparison of continuous data between groups,the chi- square test was used for comparison of categorical data between groups,the rank sum test was used for comparison of ranked data,and the Kaplan- Meier method was used for survival analysis. Results The response rate showed no significant difference between the cinobufotalin group and the anhydrous ethanol group（ 63. 0% vs 58. 6%,χ-2= 0. 111,P〈0. 05）. After treatment,the cinobufotalin group had significantly lower levels of TBil,ALT,and AST than the anhydrous ethanol group（ t = 2. 24,2. 40,and 2. 39,all P〈0. 05）. The 6- month,1- year,and 2- year survival rates showed no significant differences between the cinobufotalin group and the anhydrous ethanol group（ 81. 5% /63. 0% /29. 6% vs 82. 8% /58. 6% /31. 0%,χ-2= 0. 016,0. 111,and 0. 013,all P〈0. 05）. Conclusion Ultrasound- guided percutaneous injection of cinobufagin or anhydrous ethanol has similar short-and long- term effects in the treatment of PVTT and can inhibit the growth of tumor thrombus and prolong survival time,but cinobufagin is superior to anhydrous ethanol in the aspect of protecting liver function.

关 键 词：肝肿瘤 肿瘤循环细胞 门静脉 华蟾素 乙醇 

分 类 号：R735.7[医药卫生—肿瘤]