【作者】 王鑫森；

【导师】 王大伟；

【作者基本信息】 吉林大学 ， 临床医学， 2009， 硕士

【摘要】 外科切除是原发性肝癌的传统治疗手段,但总体切除率只有30%左右,主要原因是大部分患者合并肝炎后肝硬化,肝功能储备不足。当出现多发病灶时切除率更低。自Goldstein于1976年首次使用肝动脉化疗栓塞术(TACE)治疗肝癌以后,TACE开始在临床广泛应用。现在TACE已成为中晚期原发性肝癌主要的治疗手段,但经TACE治疗后原有的动脉供血系统受到影响,导致侧枝循环的建立,从而影响再次治疗的效果,同时多次TACE治疗会加重肝功能的损害,肿瘤复发后难以进一步治疗。如何进一步提高疗效,降低副作用成为原发性肝癌介入治疗的现实问题。近年来,肿瘤化学消融技术即PEI疗法在原发性肝癌治疗上的成功应用,为原发性肝癌的介入治疗开辟了新途径。为进一步探讨PEI在原发性肝癌综合介入治疗中的作用,笔者将PEI和TACE结合起来,并与单纯行TACE治疗的疗效进行对比性研究,寻找综合介入治疗原发性肝癌的新方法,以达到进一步提高原发性肝癌介入治疗疗效的目的。85例原发性肝癌患者分为A、B两组,A组为TACE组,54例;B组为PEI联合TACE组(联合治疗组),31例。治疗一个疗程后复查两组患者CT及DSA。结果:TACE组肿瘤完全坏死率为20.37%;1、2年生存率分别为72.22%、46.30%;瘤体周围血管再生率为79.63%;复发率为48.15%;治疗后AFP降低的比率为53.19%。联合治疗组相应值分别为80.65%;83.87%、54.84%;32.26%;25.81%;78.57%。两组治疗后肿瘤完全坏死率,第1、2年生存率,瘤体周围血管再生率,复发率,治疗后AFP降低的比率的差异均有显著意义(P<0.01)。联合治疗组疗效明显优于TACE组。PEI联合TACE,两者相互弥补,使较大肝癌的完全坏死率明显提高,从而进一步提高对肝癌的治疗效果。更多还原

【Abstract】 Purpose:To investigate the therapeutic effect of chemistry ablation(PEI)combined with transcatheter arterial chemoembolization(TACE)in treating primary hepatocellular carcinoma.Methods:To collect a total of 89 cases of primary hepatocellular carcinoma patients, 4 patients were lost, do not take part in grouping statistics. 85 cases of patients with primary hepatocellular carcinoma, 60 cases of right upper quadrant pain was admitted to hospital, for medical examination found 25 cases of intrahepatic space-occupying lesions. Grouped according to the principle of single-date and double-date law, divided into TACE group and combined therapy group. One of 54 cases of pure TACE group, and the combined therapy group were 31 cases of patients 2 weeks after TACE treatment of PEI. TACE alone group and combined therapy group 1~1.5 per month to carry out duplicate treatment, continuous treatment of duplicate 3 times for a course of treatment, all patients had a complete course of treatment. After the completion of a course of treatment, 1.5 per month CT follow-up visit one time, if stable condition, every 3~6 month CT examination, when necessary, DSA inspection trip.Results:In TACE group, the complete necrosis rate of tumor was 20.37%; one year and two year survival rate were 72.22%?46.30%; peripheral vessels of neoplasma reproduce rate was 79.63%; the recurrence rate after a course of treatment was 48.15%; the rate of AFP reduce after treatment 53.19%. Respectively corresponding value were 80.65%; 83.87% ? 54.84%; 32.26%;5.81%; 78.57%in therapeutic alliance group. There were significant statistical differences between the two group (p value smaller than 0.01) Conclusion:chemistry ablation combined with transcatheter arterial chemoem- bolization treatment of hepatocellular carcinoma was superior to pure TACE group, is a safe, effective, more economic, more in line with the clinical treatment study of integrated programs. The two groups the complete necrosis rate of tumor; one year and two year survival rate; peripheral vessels of neoplasma reproduce rate; the recurrence rate after a course of treatment; the rate of AFP reduce after treatment with a significant difference. PHC in the larger treatment should not place undue reliance on TACE surgery should be the comprehensive application of transcatheter arterial chemoembolization and percutaneous ethanol injection and neonatal kill residual tumor cells in order to improve efficacy. Each other to make up for both, so that the larger the complete necrosis of hepatocellular carcinoma was significantly increased, thereby further enhance the therapeutic effect of hepatocellular carcinoma.更多还原