经导管肝动脉化疗栓塞术治疗中晚期原发性肝癌的疗效评价

发布时间：2018-05-31 04:49

  本文选题：经导管肝动脉化疗栓塞术 + 肝癌　； 参考：《青海大学》2013年硕士论文

【摘要】：目的：采用RECIST实体瘤疗效评价标准探讨经导管肝动脉化疗栓塞术(Transcatheter hepatic arterial chemoembolization, TACE)治疗中晚期原发性肝癌（primary hepatic carcinoma，PHC）的临床疗效。 资料与方法： 1．临床资料：研究分析2011年3月至2013年2月期间经TACE治疗的40例中晚期原发性肝癌患者(年龄54.9±10.8岁)，其中男性37例，女性3例。40例患者入院后均经临床检查、实验室检查及影像学检查和/或病理证实明确诊断,均符合2001年中国抗癌协会肝癌专业委员会制定的原发性肝癌的诊断与分期标准。 入组标准：原发性肝癌中期(23例)或晚期(17例)；肝功能为Child A级(19例)或B级(21例)；经TACE术前评估，符合TACE介入治疗的适应证。 肿瘤情况：共56个病灶，其中小于等于2cm的病灶2个，大于2cm且小于等于5cm的病灶17个，大于5cm的病灶37个。 2．治疗方法： 2.1影像设备：德国西门子公司ANGIOSTAR PLUS1000MA数字减影管造影机。 2.2治疗过程：采用Seldinger穿刺插管方法,经皮股动脉穿刺插管成功后,常规在腹腔干动脉和肠系膜上动脉置管造影，以了解肝肿瘤的血液供应，判断有无肝动脉变异，以及有无异常的肝动一静脉分流，若有分流则先封堵瘘口。导管前端的位置：若给肝肿瘤供血的动脉较粗，则直接将肝管超选过去，若供血动脉较纤细，则使用同轴微导管。尽量超选择，否则会损伤正常肝组织。栓塞后造影以确定栓塞效果。 3．疗效评价和随访：①术后一月复查上腹部CT一次，评估碘化油沉积情况及肿瘤大小的变化。②术后一月复查甲胎蛋白一次，比较治疗前后的情况。③TACE术后均观察患者症状、KPS评分等情况，并根据复查结果制定下面的的治疗方案。 4．统计学方法：数据通过SPSS17.0软件进行统计学分析。差异显著性检验:计量资料之间行t检验或秩和检验;检验水准：α=0.05。 结果： 1.患者TACE术后一周临床症状的改变：第一次TACE术后，临床症状改善85%（34/40）、无明显改善10%（4/40）、加重5%（2/40）。 2.患者TACE术后一周KPS功能状态评分情况：第一次TACE术前、后KPS功能状态评分之间的差别具有统计学意义(秩和检验，PO．05)。 3.患者TACE术后一月病灶内碘化油沉积的状况：第一次TACE术后，，病灶内碘油沉积Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型构成比分别为22.5%（9/40）、22.5%（9/40）、17.5%（7/40）、7.5%（3/40）、30.0%（12/40）；Ⅰ型、Ⅱ型和Ⅲ型构成比合计为62.5%。 4.患者TACE术后一月AFP的改变：患者第一次TACE术前、后AFP值之间的差别具有统计学意义(秩和检验，PO．05)。 5.患者TACE术后，采用RECIST实体瘤疗效评价标准，计算总有效率：第一次TACE术后：CR0例,PR19例,SD9例,PD12例,总有效率为47.5%；第二次TACE术后：CR0例,PR5例,SD6例,PD4例,总有效率为33.3%；第三次TACE术后：CR0例,PR2例,SD2例,PD2例,总有效率为33.3%。 6.患者TACE术后病灶明显缩小至5cm以内者达7例,可以再次争取外科手术切除。 7.患者无进展生存时间：TACE术后，患者无进展生存时间中位数为86天(20-609天)。 8.生存率：TACE术后随访，患者6个月及12个月的生存率分别为77.5%（31/40）、42.5%（17/40）。 结论：经导管肝动脉化疗栓塞术(TACE)是中晚期原发性肝癌的有效治疗手段,能有效改善患者临床症状，提高生存质量，为再次争取外科手术切除创造条件，并延长患者生命。
[Abstract]:Objective: To evaluate the clinical efficacy of Transcatheter hepatic arterial chemoembolization (TACE) in the treatment of advanced primary liver cancer (primary hepatic carcinoma, PHC) by using the standard of RECIST solid tumor.
Information and methods:
1. clinical data: analysis of 40 patients with advanced primary liver cancer (age 54.9 + 10.8 years) treated by TACE from March 2011 to February 2013, including 37 males and 3 cases of female.40 patients after admission to hospital, laboratory examination, imaging examination and / or pathophysiology confirmed diagnosis, all in accordance with the China anticancer Association in 2001. Criteria for diagnosis and staging of primary liver cancer developed by Specialized Committee.
Criteria: primary liver cancer (23 cases) or late stage (17 cases); liver function Child a (19 cases) or class B (21 cases); the preoperative assessment of TACE accords with the indication of TACE intervention.
Tumor situation: a total of 56 lesions, of which 2 lesions less than or equal to 2cm, 17 lesions larger than 2cm and less than 5cm, 37 lesions larger than 5cm.
2. treatment methods:
2.1 imaging equipment: SIEMENS ANGIOSTAR PLUS1000MA digital subtraction angiography machine.
2.2 treatment process: using Seldinger puncture intubation method, after percutaneous femoral artery puncture intubation successfully, the normal abdominal dry artery and the superior mesenteric artery angiography were used to understand the blood supply of the liver tumor, determine the hepatic artery variation, and have abnormal hepatic arteriovenous shunt, if there is shunt, the fistula first is blocked. The front end of the catheter is first. Position: if the arterial blood supply to the liver tumor is thicker, then the liver tube is over selected. If the blood supply is thin, the coaxial micro catheter is used. The best choice is possible, otherwise the normal liver tissue will be damaged. The embolic effect is determined by the embolization.
3. evaluation and follow-up: 1 month after the operation of the upper abdomen CT, evaluate the status of the iodized oil deposition and the size of the tumor. 2. After one month reexamination of alpha fetoprotein, compare the situation before and after treatment. (3) after TACE, the symptoms of the patients, KPS score and so on were observed, and the following treatment was established according to the results of the reexamination.
4. statistical method: statistical analysis of data through SPSS17.0 software. Difference significance test: t test or rank sum test between measurement data; test level: alpha =0.05.
Result锛

本文编号：1958346