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目的:对比观察不同化疗药物剂量经动脉导管灌注化疗栓塞术(transcather arterial chemoembolization,TACE)治疗中晚期原发性肝癌的疗效及对肝纤维化指标的影响. 方法:75例原发性肝癌患者随机分为A、B两组,A组应用常规化疗药物剂量、B组应用小剂量化疗药物进行TACE 术,两组所用药物种类及栓塞材料相同,TACE术3次/例, 手术间隔35±7 d.观察近期疗效和远期生存率,测定每次TACE术前及第三次术后2 mo时患者血清中肝纤维化指标: 透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原肽(PC Ⅲ)和Ⅳ型胶原(Ⅳ-C)含量. 结果:近期疗效,A组:完全缓解(CR)5例(11.1%)、部分缓解(PR)24例(53.3%)、无变化(NC)12例(26.7%)、进展(PD)4例(11.1%);B组:CR 2例(6.7%)、PR 17例(56.7%)、NC 9例(30%)、PD 2例(6.7%),无统计学差异.两组患者的6 mo、1 a、2 a、3 a生存率分别是:84.4% vs 86.7%、53.3% vs 60%、21)%vs 33.3%、11.1% vs 17%,经检验,无明显差异:A组患者肝纤维化指标在第一次TACE术后即明显升高,有显著性差异,治疗结束后差异更加明显(P<0.01);B组患者肝纤维化指标在第3次TACE术后2 mo才明显升高(P<0.05). 结论:小剂量化疗药物TACE术与常规药物剂量TACE术治疗原发性肝癌疗效无明显不同,但前者有利于维护肝功能状态,减轻肝纤维化的发生,值得临床推荐.
OBJECTIVE: To compare the effects of transcatheter arterial chemoembolization (TACE) with different chemotherapeutic agents on the treatment of advanced primary hepatocellular carcinoma (HCC) and its effect on the indexes of liver fibrosis.Methods: Seventy-five patients with primary hepatocellular carcinoma Divided into A, B two groups, A group using conventional chemotherapy dose, B group using low-dose chemotherapy drugs for TACE surgery, the two groups of drugs and embolic material used the same, TACE 3 times / cases, the operation interval 35 ± 7 d The short-term curative effect and long-term survival rate were observed and the indexes of hepatic fibrosis in serum of patients before and after the second TACE were determined: hyaluronic acid (HA), laminin (LN) Collagen peptide (PC Ⅲ) and type Ⅳ collagen (Ⅳ-C) were determined.Results: The short-term curative effect was as follows: In group A, 5 cases (11.1%) of complete remission (CR), 24 cases (53.3%) of partial remission In group B, CR (6.7%), PR 17 (56.7%), NC 9 (30%), PD The survival rates at 6 months, 1 year, 2 years and 3 months after operation were 84.4% vs 86.7%, 53.3% vs 60%, 21% vs 33.3%, respectively, and there was no significant difference between the two groups , 11.1% vs 17%, after testing, no significant difference : A group of patients with liver fibrosis index after the first TACE was significantly increased, there was a significant difference, the difference was more significant after treatment (P <0.01); B group of patients with liver fibrosis in the third TACE (P <0.05) .Conclusion: The effect of low-dose chemotherapy TACE and conventional drug dose TACE on primary hepatocellular carcinoma is not significantly different, but the former is conducive to maintaining liver function and reducing liver fibrosis The occurrence of, it is clinically recommended.