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目的 探讨大肝癌经肝动脉门静脉化学药物栓塞治疗 (TACE +PVCE)缩小后 ,再行 2期外科综合性治疗的治疗效果。方法 对大肝癌 48例行TACE +PVCE治疗。癌灶明显缩小后 ,15例行肝癌切除术 ;在B型超声引导下经皮经肝穿刺 ,2 3例行癌灶内无水酒精注射 ,10例行癌灶深度冷冻。结果 TACE +PVCE治疗后 ,肝癌癌灶由平均直径 10 6cm缩小到 4 6cm ;AFP阳性 2 7例中 ,降至正常 19例 ;在切除的肝癌标本 15例中 ,癌灶已完全坏死 9例 ,癌灶坏死范围超过 6 0 %者 6例。 2期外科综合治疗后的 1、3、5年生存率分别为 86 % ,6 8%和 5 7%。其中手术切除组 5年生存率 6 2 % ,略高于无水酒精注射 (5 5 % )和深度冷冻组 (47% ) (P <0 0 5 )。结论 TACE +PVCE可使大肝癌缩小 ,并为 2期外科综合治疗提供机会 ,根据肝癌及患者的具体情况 ,选用相应的 2期治疗方法 ,可获较满意的疗效。
Objective To investigate the therapeutic effect of surgical comprehensive treatment of 2 large hepatocellular carcinoma after transcatheter arterial chemoembolization via hepatic artery (TACE + PVCE). Methods 48 cases of large hepatocellular carcinoma treated with TACE + PVCE. Fifteen patients underwent hepatectomy after the lesion was significantly reduced. Percutaneous transhepatic puncture was performed under the guidance of B-mode ultrasound. Twenty-three patients underwent non-alcoholic injection in the foci and 10 patients underwent deep freezing in the foci. Results After TACE + PVCE treatment, the foci of hepatocellular carcinoma were reduced from 106cm to 46cm in average diameter. Among the 27 cases with AFP positive staining, 19 cases were reduced to normal. Among the 15 cases of resected hepatocellular carcinoma, the lesions were completely necrotic in 9, Tumor necrosis range more than 60% in 6 cases. The 1, 3, 5 year survival rates after 2 surgical surgeries were 86%, 68% and 57%, respectively. The 5-year survival rate of the surgical resection group was 62%, slightly higher than that of the anhydrous alcohol injection (55%) and the deep-frozen group (47%) (P <0.05). Conclusions TACE + PVCE can reduce large hepatocellular carcinoma and provide opportunities for second-stage surgical treatment. According to the specific conditions of liver cancer and patients, the corresponding second-phase treatment can be used to obtain satisfactory results.