125I粒子植入联合肝动脉化疗栓塞术预防原发性肝癌合并门静脉癌栓消化道出血  

The value of 125iodine implantation combining transcatheter arterial chemoembolization to prevent digestive tract bleeding in patients with portal vein tumor thrombus in primary hepatocellular carcinoma

作　　者：蒋丽[1] 韩东明[2] 胡鸿涛[1] 马俊丽[1] 赵妍[1] 黎海亮[1] 郭晨阳[1] 姚全军[1] Jiang Li Han Dongming Hu Hongtao Ma Junli Zhao Yan Li Hailiang Guo Chenyang Yao Quanjun(Department of Interventional Radiology ,Henan Provincial Cancer Hospital ,Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, Chin)

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院放射介入科,450008 [2]新乡医学院第一附属医院影像诊断科

出　　处：《中华放射学杂志》2016年第10期784-788,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金面上项目（U1504816）;河南省医学科技攻关计划项目（201203155）

摘　　要：目的：探讨125I粒子植入联合肝动脉化疗栓塞术（TACE）预防原发性肝癌（PHC）合并门静脉癌栓（PVTT）患者消化道出血的价值。方法前瞻性收集按照中国抗癌协会原发性肝癌诊断标准确诊为PHC合并PVTT的40例患者，通过随机化表法随机分为治疗组和对照组，每组20例。治疗组采用肝内肿瘤TACE＋门静脉癌栓125I粒子植入的方法治疗；对照组采用肝内肿瘤TACE＋口服β受体阻滞剂治疗。观察患者术后并发症及不良反应。术后3个月行腹部增强CT扫描评估疗效，分为完全缓解（CR）、部分缓解（PR）、进展（PD）和稳定（SD），计算局部控制率；记录术后3、6及12个月的消化道出血情况和生存情况。采用连续校正的χ2检验比较两组消化道出血的发生率，生存分析采用Kaplan-Meier法，并行Log-rank检验比较生存率。结果40例患者均成功完成治疗，未发生与手术相关的严重并发症。治疗组PR 8例、SD 6例、PD 6例，局部控制率为40%（8/20）；对照组PR 1例、SD 6例、PD 13例，局部控制率为5%（1/20）。两组间局部控制率的差异有统计学意义（χ2=5.161，P=0.023）。治疗组3、6及12个月发生上消化道出血的患者分别为2、2、3例，对照组分别为2、6、10例。两组间治疗后3个月、6个月出血率的差异无统计学意义（P值分别为1.000、0.235），术后12个月治疗组出血率低于对照组，差异有统计学意义（P=0.041）。治疗组和对照组1年的累计生存率分别为70%（14/20）和40%（8/20），两差异有统计学意义（χ2=4.675，P=0.031）。结论125I粒子植入联合TACE治疗PHC合并PVTT患者，能够降低消化道出血的发生率，提高生存率。Objective This study was to investigate the value of CT guided 125iodine implantation combining transcatheter arterial chemoembolization（TACE） to prevent digestive tract bleeding in patients with portal vein tumor thrombus in primary hepatocellular carcinoma. Methods Forty patients with portal vein tumor thrombus which were diagnosed to have primary hepatocellular carcinomas by diagnostic criteria of Chinese Anti-Cancer Association were collected prospectively. They were divided into the treatment group and the control group, with 20 patients in each group. The treatment group was treated by TACE for hepatic tumor and 125iodine seed implantation for portal vein tumor thrombus, while the control group was treated by TACE for hepatic tumor and only given β-blockers medicines after treatment. Intraoperative and postoperative surgery-related complications were observed. Three months after surgery, enhanced abdominal CT scanning was performed to evaluate treatment effects which were divided into complete response （CR）, partial response （PR）, and progressive disease （PD） and stable of disease （SD）, and the local tumor control rates were calculated. The bleeding rates and mortality after 3 months, 6 months, 12 months were recorded.＆amp;nbsp;Treatment effects of the two groups were compared with continuously correction Chi-square test, bleeding rates were compared with Fisher test, and survival rates were analyzed with Kaplan-Meier survival curve and compared with Log-rank test. Results Overall the 40 patients were treated successfully without serious surgery-related complications. In the treatment group, there were 8 patients with PR, 6 with SD and 6 with PD, and the local control rates were 40% （8/20）. In the control group, there were 1 patient with PR, 6 patients with SD and 13 with PD. The difference of the local control rates was statistically significant （χ2=5.161, P=0.023）.The bleeding rates at 3, 6 and 12 months were 2, 2 and 3 cases in the treatment group, for control group they w

关 键 词：肝肿瘤 门静脉 胃肠出血 放射学 介入性 

分 类 号：R735.7[医药卫生—肿瘤]