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目的 分析原发性肝癌根治性切除术后经皮下植入式药物输注系统(DDS)区域辅助化疗预防转移复发的效果。方法 1995年1月至1997年12月同一手术组行肝癌根治性切除并有肿瘤巨大、多灶、包膜不完整、伴有血管侵犯等转移复发危险因素者308例,其中115例于术中经肝动脉和(或)门静脉放置DDS作为试验组,193例未置DDS作为对照组。试验组在术后4～6周经DDS行肝脏区域化疗栓塞,此后视情况隔2～4个月重复一次,对照组则不做对转移复发有影响的辅助治疗。结果 随访至2002年3月,1、3、5、7年累积转移复发率:试验组为5.8％、22.3％、28.6％和43.9％,明显低于对照组的16.8％、39.7％、59.64％和59.64％(P<0.001)。中位转移复发时间:试验组为30.6个月,明显长于对照组的20.9个月(P<0.001)。1、3、5、7年生存率:试验组为96.8％、91.3％、84.8％和77.7％,明显高于对照组的87.3％、73.8％、63.6％和5&7％(P<0.001)。结论 肝癌根治术后经DDS区域辅助栓塞化疗既推迟了转移复发时间又降低了转移复发率。
Objective To analyze the effect of adjuvant chemotherapy in prevention and treatment of metastasis and recurrence after subcutaneous implantable drug delivery system (DDS) in patients with primary liver cancer after radical resection. Methods From January 1995 to December 1997, the same operation group underwent radical resection of liver cancer and there were 308 cases of tumor risk factors such as giant tumor, multifocal and incomplete capsule with the risk of metastasis such as vascular invasion. Of the 115 cases, DDS was placed in the hepatic artery and / or portal vein as experimental group, and 193 patients without DDS as control group. The experimental group was treated with DDS in the liver region 4 to 6 weeks after the operation. After that, the patients in the test group were repeated every 2 to 4 months, while the control group did not have adjuvant therapy that had an influence on the recurrence and metastasis. Results The recurrence rate of cumulative metastasis at 1, 3, 5 and 7 years after follow-up was as follows: the test group was 5.8%, 22.3%, 28.6% and 43.9% respectively, significantly lower than the control group by 16.8%, 39.7% and 59.64% And 59.64% (P <0.001). Median metastatic relapse time: The test group was 30.6 months, significantly longer than the control group of 20.9 months (P <0.001). The 1-, 3-, 5-, 7-year survival rates were 96.8%, 91.3%, 84.8% and 77.7% in the experimental group, which were significantly higher than 87.3%, 73.8%, 63.6% and 5% and 7% of those in the control group (P <0.001). Conclusion After radical resection of liver cancer, adjuvant embolization with DDS chemotherapy not only delayed the time of metastasis but also reduced the recurrence rate.