论文部分内容阅读
目的观察经肝动脉化疗栓塞术(TACE)联合~(125)I放射性粒子植入序贯治疗近心旁原发性肝细胞肝癌(HCC)的临床疗效及可行性。方法选取癌灶位于近心旁的67例HCC患者,随机分为观察组35例和对照组32例;观察组行TACE联合~(125)I放射性粒子植入序贯治疗,对照组单纯行TACE治疗。取术前及术后第1个月静脉血检测AFP、AST、ALT、ALB,术后第3个月复查MRI评价近期疗效;术后随访36个月,计算生存率。结果与术前相比较,两组术后第1个月血AFP、AST、ALT降低而ALB升高,且观察组改善程度较对照组明显,差异有统计学意义(P均<0.05)。观察组总体有效率为74.3%、疾病控制率为88.6%,显著高于对照组的28.1%、65.6%(P均<0.05)。观察组术后6、12、36个月生存率分别为88.6%、77.1%、42.9%,明显高于对照组的50.0%、34.4%、18.8%(P均<0.05)。术后第3天观察组中心肌酶谱出现轻度改变3例,5例出现放射性胃肠反应改变,均对症处理后好转。结论 TACE联合~(125)I放射性粒子植入序贯治疗近心旁HCC安全、有效。
Objective To observe the clinical efficacy and feasibility of transcatheter hepatic arterial chemoembolization (TACE) combined with 125 I radioactive seed implantation in the treatment of parahepatic primary hepatocellular carcinoma (HCC). Methods Totally 67 cases of HCC with adjacent carcinoma were randomly divided into observation group (n = 35) and control group (n = 32). TACE combined with (125) I radioactive seed implantation was performed in observation group. TACE treatment. AFP, AST, ALT, ALB were measured before and after the first month of operation, and the short-term effect was evaluated by MRI at the third month after operation. The patients were followed up for 36 months to calculate the survival rate. Results Compared with preoperative, blood AFP, AST and ALT decreased and ALB increased at the first month after operation in both groups. The improvement in observation group was more significant than that in control group (P <0.05). The total effective rate in the observation group was 74.3%, disease control rate was 88.6%, which was significantly higher than that in the control group (28.1%, 65.6%, P <0.05). The survival rates at 6,12,36 months after operation in the observation group were 88.6%, 77.1% and 42.9%, respectively, which were significantly higher than those in the control group (50.0%, 34.4%, 18.8%, P <0.05). On the third day after operation, myocardial enzymes in the observation group showed mild changes in 3 cases and in 5 cases, radioactive gastrointestinal reactions changed, all of which were improved after symptomatic treatment. Conclusion TACE combined with ~ (125) I radioactive particle implantation is safe and effective in the treatment of paracenseral HCC.