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目的:比较经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)和手术治疗原发性大肝癌(肿瘤最大直径≥5 cm)的临床疗效和安全性。方法:回顾性分析48例经TACE或手术(Operation)治疗的原发性大肝癌患者,其中TACE组25例,Operation组23例,治疗后随访24个月,评价和比较其治疗效果、生存曲线、镇痛剂的日平均用量及不良反应的发生情况。结果:治疗后3个月,TACE组患者的Karnofsky评分(P=0.033)显著高于Operation组,而血清甲胎蛋白(AFP)水平(P=0.022)显著低于Operation组。此外,TACE组的镇痛药杜冷丁的日均使用量显著低于Operation组(P=0.031),便秘的日均发生次数(P=0.045)显著少于Operation组。治疗后24个月,TACE组和Operation组的生存率分别为48.0%和17.4%,TACE组显著高于Operation组(P=0.0415,95%CI of ratio:1.006 to 1.994)。结论:TACE治疗原发性大肝癌的临床疗效可能优于手术治疗,且安全性高。
Objective: To compare the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) and surgical treatment of primary large hepatocellular carcinoma (maximal tumor diameter ≥5 cm). Methods: Forty-eight patients with primary hepatocellular carcinoma treated by TACE or operation were retrospectively analyzed. Among them, 25 patients in the TACE group and 23 in the operation group were followed up for 24 months after treatment. The therapeutic effect and survival curve were evaluated and compared , The average daily dosage of analgesics and the incidence of adverse reactions. Results: At 3 months after treatment, the Karnofsky score (P = 0.033) in the TACE group was significantly higher than that in the Operation group, while the serum AFP level (P = 0.022) was significantly lower than that in the Operation group. In addition, the average daily use of pethidine for the analgesic drug in the TACE group was significantly lower than that in the Operation group (P = 0.031). The average daily incidence of constipation (P = 0.045) was significantly less than that in the Operation group. At 24 months after treatment, the survival rates in TACE group and Operation group were 48.0% and 17.4%, respectively, and in TACE group were significantly higher than those in Operation group (P = 0.0415, 95% CI of ratio: 1.006 to 1.994). Conclusion: TACE treatment of primary hepatocellular carcinoma clinical efficacy may be superior to surgery, and high safety.