【作者】 赵昌；

【导师】 马亦龙；

【作者基本信息】 广西医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 目的:探讨经导管肝动脉化疗栓塞(TACE)联合微波消融(MCT)治疗中晚期肝癌的临床疗效及临床应用价值。方法:回顾分析2004年12月至2006年9月间在广西肿瘤医院接受TACE及TACE+PMCT治疗的资料完整的中晚期肝癌患者共83例,其中以单纯行TACE治疗的55例患者做为对照组,行TACE+PMCT治疗的28例患者为实验组(两组资料具有可比性)。两组病人首次行TACE术治疗:经导管予肿瘤供血动脉内灌注5-氟尿嘧啶(5-FU)750~1000mg及表阿霉素(EPI)40~60mg或顺铂(DDP)40~60mg;用丝裂霉素(MMC)10~14mg及碘化油(LP)10~30ml混合乳剂对肿瘤供血动脉进行栓塞,必要时加用明胶海绵颗粒强化栓塞;对合并有肝动门脉瘘者(HAPS)先行瘘口栓塞,闭塞瘘口后再行肿瘤栓塞。常规每次TACE治疗后3~4周复查CT或肝动脉造影,根据碘油缺失、瘘口再通、癌灶残留及病灶进展等情况综合评定,再选择性行TACE或PMCT治疗,连续治疗3次为一个周期。观察比较两组有效率、AFP平均下降率、毒副作用、复发转移率、生存期。评价TACE联合PMCT治疗中晚期肝癌的临床疗效。结果:两组病例经治疗后临床症状均得到改善,生存质量明显提高;⑴有效率:一个周期结束后,经肝脏增强CT扫描评价,实验组有效率为67.86%,对照组为40.00%,两组比较差异有统计学意义(P<0.05),实验组高于对照组;⑵治疗后AFP平均下降率:实验组为76.00%,对照组为47.92%,两组差异有统计学意义(P<0.05);⑶生存时间:实验组中位生存期为30个月,对照组中位生存期24个月,两组0.5年、1年、1.5年、2年累积生存率分别为100%、93%、79%、61%、和95%、84%、65%、38%,两组疗法的生存期对比差异有显著性意义(P<0.05);⑷复发转移率:实验组和对照组治疗中晚期肝癌患者的0.5年、1年、2年累积复发转移率分别为7.14%、14.29%、32.14%和9.09%、34.55%、65.45%,两组差别有统计学意义(P<0.05),实验组复发转移率明显低于对照组;⑸毒副作用:两组毒副作用相似,均未发生严重并发症;(6)肝动-门脉瘘:对照组8例经TACE术反复封堵后仍有3例发生瘘口再通,实验组5例经TACE+PMCT治疗后未出现瘘口再通。结论:TACE联合PMCT综合治疗中晚期肝癌是安全、可行、有效的治疗方法,其临床疗效优于单纯行TACE治疗,可延长患者生存期,降低复发率,不增加毒副作用。更多还原

【Abstract】 Objective:To evaluate the clinical effect and application value of transcatheter hepatic arterial chemoembolization(TACE) combined with percutaneous microwave ablation therapy(PMCT) in patients with advanced liver cancer.Methods:Retrospective analysis of 83 patients with advanced liver cancer rece- ived TACE and TACE combined with PMCT in GuangXi Cancer Hospital from Dec- ember 2004 to September 2006 . 55 patients performed only in TACE were enrolled in control group. 28 patients were treated with TACE+PMCT as the therapy group . The patients were performed firstly in TACE and received 5-FU (750~1000mg) +EPI (40~60mg) or DDP (40~60mg)+the emulsion(10~30ml) constituted by MMC(10~14 mg )and LP (10~30ml) to chemoembolization feeding artery of liver cancer;And gelatin sponge particles were used to Strengthen the embolization necessarily. The HAPS were blocked up before cure tumor .CT inspection was performed after every post-Treatment 3~4 weeks.TACE or TACE+PMCT was selected to patients again accor- ding to the condition of fistula and tumor.The continuous three treatments was a period of treatment.Then followed up the therapeutic effect rates,reduced rates of AFP,side effects,the rates of recurrence and metastasis,survival time of the two groups . Results: The effect rates were 67.86% and 40.00% in the therapy group and the control group ,respectively(P<0.05);The average reduced rates of AFP was 76.00% and 47.92% in the therapy group and control group ,respectively(P<0.05);The med- ian survival time and 0.5-,1-,1.5-,2-year cumulative survival rate were 30 months、100% 93%、79%、61%and 24months、95%、84%、65%、36% in the therapy group and control group ,respectively(P<0.05);The 0.5-,1-,2-year cumulative recurrence and metastasis rate were 7.14%、14.29%、32.14% and 9.09%、34.55%、65.45% in the therapy group and control group ,respectively(P<0.05);The side effects of two groups were similar and the serious complications were not found;8 HAPS in the control group were blocked up repeatedly with TACE , 3 of them were recanalized yet. 5 HAPS in the therapy group were completely blocked, none of them was recanalized again.Conclusions:TACE combined with PMCT could safely and effectively treat the Patients with anvanced liver cancer,and extend life span, reduce recurrence rate and not increase side effects.更多还原