肝动脉化疗栓塞联合持续动脉灌注化疗治疗结直肠癌肝转移的疗效分析

发布时间：2018-04-16 17:36

  本文选题：结直肠癌肝转移 + 雷替曲塞　； 参考：《山西医科大学》2017年硕士论文

【摘要】：目的:肝脏是CRC常见远处转移的器官,外科手术切除可做到根治性治疗,但是80%-90%的患者因各种原因无法接受手术,介入治疗因自身优势受到普遍关注。本研究通过观察、分析应用RA行肝动脉灌注化疗术TAI+化疗栓塞术TACE治疗结直肠癌肝转移CRCLM的近期疗效及安全性,并为进一步研究奠定基础,以此推动这种联合方案在CRCLM治疗中的研究应用。方法:收集2013年1月至2016年8月期间,山西医科大学附属第一医院介入病房收治的CRCLM患者23例,所选CRCLM患者至少接受2个周期静脉化疗,但仍为进展期。超选择肝转移灶的供血动脉,先将OXA与适量Lipiod混合后缓慢注入填充,后将MICRO留置于责任血管近端,由体外经MICRO持续先后灌注化疗药物(OXA 100mg和RA3mg),记录患者术后的不良反应情况及术后4-6周复查的近期疗效。结果:1.依据近期疗效标准:完全缓解CR 0例,部分缓解PR 8例(34.78%),疾病稳定SD 11例(47.83%),疾病进展PD 4例(17.39%),有效率RR 8例(34.78%),疾病控制率DCR 19例(82.61%)。2.依据转移灶数进行分组,其中3个转移灶CR 0例,PR 1例(20.0%),SD 3例(60.0%),PD 1例(20.0%),RR 1例(20.0%),DCR 4例(80.0%);≥3个转移灶CR 0例,PR 7例(38.39%),SD 8例(44.44%),PD 3例(16.67%),RR 7例(38.89%),DCR 15例(83.33%)。两组的RR、DCR的P0.05,无显著性差异。3.介入治疗后根据药物毒性反应分级标准:术后3天之内大多数会出现不同程度的栓塞后综合征,肝区不适(37次,59.68%)、疼痛(36次,58.06%)、恶心呕吐(29次,46.77%)、纳差(41次,66.13%)、乏力(30次,48.39%)和发热(36次,58.06%)等,经对症处理后1-2周后均能很快缓解。患者共计62次治疗,术后无严重不良反应。结论:1.对于CRCLM全身化疗仍为进展的患者,TAI+TACE联合方案提供了另一种有效的选择。2.选用RA行TAI+TACE治疗CRCLM疗效确实,无严重毒副反应。3.病灶个数对TAI+TACE联合方案治疗结直肠癌肝转移的疗效无影响,疾病控制率均达到80%以上。
[Abstract]:Objective: liver is a common organ with distant metastasis in CRC. Surgical resection can achieve radical treatment, but 80% to 90% of patients can not accept surgery for various reasons, and interventional therapy is generally concerned because of its own advantages.In this study, the short-term efficacy and safety of RA with hepatic artery infusion chemotherapy, TAI chemoembolization and TACE in the treatment of colorectal cancer with hepatic metastasis CRCLM were analyzed, which laid a foundation for further study.In order to promote the combination of this regimen in the treatment of CRCLM research and application.Methods: from January 2013 to August 2016, 23 patients with CRCLM were treated in the interventional ward of the first affiliated Hospital of Shanxi Medical University. The selected CRCLM patients received at least two cycles of intravenous chemotherapy, but they were still advanced.The blood supply artery of liver metastases was superselected. OXA was mixed with moderate amount of Lipiod, then filled slowly, then MICRO was placed in the proximal end of the responsible blood vessel.OXA 100mg and RA3 mg / L were continuously infused through MICRO in vitro to record the adverse reactions of the patients and the short term efficacy of 4 to 6 weeks after operation.The result is 1: 1.According to the short-term curative effect criteria: complete CR 0 cases, partial remission PR 8 cases with 34.78T, disease stable SD 11 cases 47.83%, disease progression 4 cases 17. 39%, effective rate RR 8 cases 34. 7881%, disease control rate 19 cases (82.61%).According to the number of metastatic foci, there were 3 cases of CR 0 cases of PR and 20.0 cases of SD 3 cases of PD. One case of PD was 20. 0%, 1 case was 20. 0% of RR, 1 case was 20. 0% of DCR 4 cases, 鈮，

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