论文部分内容阅读
目的:观察门静脉灌注化疗治疗原发性肝癌伴门静脉癌栓的临床效果。方法:选择原发性肝癌伴门静脉主干或门静脉左、右分支癌栓106例,随机分为观察组和对照组各53例。观察组采用超声引导下门静脉灌注化疗联合经皮穿刺微波消融(PMCT),对照组仅采用超声引导下PMCT治疗。治疗后定期对所有入组病例进行彩色多普勒超声(彩超)检查或超声造影、肝癌血清学指标甲胎蛋白(AFP)检测、门静脉癌栓变化或形成情况检查,比较两组AFP转阴率和门静脉癌栓变化情况;随访3个月~5年,比较两组复发率和生存率。结果:两组术后均出现发热,持续1~7天后恢复正常;部分病例伤口轻微疼痛,1~3天后缓解。未发生烫伤及肝包膜下出血、胆瘘等并发症。两组化疗后不良反应均较轻微,未发生脱发及明显骨髓抑制等情况。治疗后2周,观察组AFP转阴率及癌栓缩小率均非常显著高于对照组(P<0.01),瘤栓复发率非常显著低于对照组(P<0.01)。随访6个月、1年、2年、3年、5年,观察组肿瘤复发率非常显著低于对照组(P<0.01),生存率非常显著高于对照组(P<0.01)。结论:门静脉灌注化疗联合PMCT治疗原发性肝癌及门静脉癌栓,近远期疗效显著,并可降低复发率,延长患者生存期。
Objective: To observe the clinical effect of portal vein chemotherapy in the treatment of primary liver cancer with portal vein tumor thrombus. Methods: A total of 106 primary hepatocellular carcinoma patients with portal vein thrombosis and portal vein thrombosis were divided into observation group (53 cases) and control group (106 cases). The observation group underwent ultrasound-guided portal vein infusion chemotherapy combined with percutaneous transluminal microwave ablation (PMCT), while the control group received ultrasound-guided PMCT only. After treatment, all patients were enrolled in the study. Color Doppler ultrasonography (Doppler echocardiography) or contrast-enhanced ultrasound (CEUS), AFP detection, portal vein thrombosis or formation of portal vein were performed regularly. And portal vein tumor thrombus changes; follow-up of 3 months to 5 years, the recurrence rate and survival rate were compared between the two groups. Results: Both groups experienced fever after operation and returned to normal after 1 to 7 days. In some cases, the wounds were slightly painful and were relieved after 1 to 3 days. No scald and liver capsule hemorrhage, biliary fistula and other complications. Adverse reactions after the two groups of chemotherapy were mild, no hair loss and significant bone marrow suppression and so on. Two weeks after treatment, the rate of AFP negative conversion and the rate of tumor shrinkage in the observation group were significantly higher than those in the control group (P <0.01). The recurrence rate of tumor emboli was significantly lower than that of the control group (P <0.01). The follow-up of 6 months, 1 year, 2 years, 3 years and 5 years showed that the recurrence rate of the observation group was significantly lower than that of the control group (P <0.01), and the survival rate was significantly higher than that of the control group (P <0.01). Conclusion: Intravenous infusion chemotherapy combined with PMCT in the treatment of primary hepatocellular carcinoma and portal vein tumor thrombus has significant short-term and long-term curative effect, and can reduce the recurrence rate and prolong the survival of patients.