碘125粒子联合肝动脉化疗栓塞术治疗原发性肝癌合并门脉分支癌栓疗效分析  

Endovascular placement of iodine-125 seed strand combined with chemoembolization for the treatment of hepatocellular carcinoma with tumor thrombus in portal vein

作　　者：邵海波[1] 马腾闯 牛猛[1] 侯国瑜[1] 徐文涵[1] 李帅[1] 苏洪英[1] 徐克[1] 

机构地区：[1]中国医科大学附属第一医院介入放射科,辽宁沈阳110001

出　　处：《临床军医杂志》2016年第4期377-381,共5页Clinical Journal of Medical Officers

摘　　要：目的探讨碘125(^(125)I)粒子联合TACE治疗原发性肝癌合并门脉分支癌栓患者的临床疗效和安全性。方法收集中国医科大学附属第一医院自2013年1月至2015年12月经病理检查或影像学证实的诊断为原发性肝癌伴门脉分支癌栓的患者89例,分为治疗组(n=47)和对照组(n=41)。治疗组患者给予患者超声引导下行门脉癌栓125I粒子植入术及TACE治疗;对照组患者进行传统的TACE治疗。末次随访时间为2016年1月31日。主要研究终点是总体生存期(OS),次要终点包括:术后1个月的疗效评价及不良反应的评价。同时,对影响OS的因素进行分析。结果治疗组与对照组的OS分别为17.8个月和8.4个月(P<0.05)。通过COX模型分析发现,肝内病灶最大径是否>5 cm是影响OS的主要因素(P<0.01)。治疗组与对照组疾病有效率(RR)分别为89.5%、41.5%(P<0.05),疾病控制率(DCR)分别为94.7%、56.8%(P<0.05);两组患者主要不良反应为发热、恶心呕吐、肝区疼痛、转氨酶升高及白蛋白减低等,但不良反应发生率方面差异均无统计学意义(P>0.05)。结论125I粒子联合TACE在肝癌合并门脉分支癌栓患者的治疗中可以有效延长患者的生存期,值得进一步研究。Objective To investigate the clinical efficacy and safety of transcatheter chemoembolization （ TACE ） with iodine-125 in treating the hepatocellular carcinoma with tumor thrombus in portal vein. Methods A total of 89 patients with pathologically-proved or clinical-confirmed primary hepatic carcinoma with portal vein thrombus in our hospital from January 2013 to December 2015. All the patients were divided into the study group（n=47）and control group（n=41）. The study group were performed by iodine-125 with TA-CE, the control group were performed by traditional TACE. The end of the follow-up period was January 31, 2016. The primary study endpoint was overall survival, and the secondary study endpoint were the evaluation of the efficacy one month after the treatment and the evaluation of adverse reactions. The factors associated with OS were also analyzed between two groups. Results The OS values of the study group and control group were 17. 8 months and 8. 4 months respectively（P〈0. 05）,whether the diameter of the tumor in liv-er more than 5 cm was the independent factor for OS（P〈0. 01）. The response rate（RR）of the two groups was 89. 5% and 41. 5% re-spectively（P〈0. 05）,and the disease control rate（DCR）of the two groups was 94. 7% and 56. 8% respectively（P〈0. 05）. The main adverse reactions in the two groups were fever、nausea and vomiting、pain in the liver region、the elevation of transaminase and the reduction of albumin, but the differences between the two groups were not statistically significant （P〉0. 05）. Conclusion Iodine-125 combined with TACE can significantly extend the OS of patients with hepatocellular carcinoma with tumor thrombus in portal vein, and this technique is worth to be further studied.

关 键 词：碘125 原发性肝癌 肝动脉化疗栓塞术 总体生存期 

分 类 号：R730.56[医药卫生—肿瘤] R735.7[医药卫生—临床医学]