海藻酸钠微球与明胶海绵在TACE治疗肝癌中的疗效对比

发布时间：2018-06-02 02:37

本文选题：原发性肝癌 + 肝动脉化疗栓塞　；参考：《山东大学》2015年硕士论文

【摘要】：原发性肝癌是消化系统常见的恶性肿瘤,早期发病隐匿,等到确诊时往往已经到了中晚期,手术效果欠佳。现在以TACE为主的微创介入治疗成为中晚期肝癌主要的治疗手段。TACE主要是将导管选择性或超选择性插入到肿瘤供血靶动脉后,使用化疗药物进行局部化疗并以适当的速度注入适量的栓塞剂,使靶动脉闭塞,引起肿瘤组织的缺血坏死。栓塞在TACE治疗肝癌的过程中起到非常重要的作用,因此选择合适的栓塞剂对TACE疗效至关重要。目的观察海藻酸钠微球与明胶海绵两种栓塞剂在TACE治疗原发性肝癌中的疗效。方法按选用栓塞剂的不同将40例原发性肝癌患者随机平均分为两组：KMG组(20例)：采用海藻酸钠微球栓塞治疗,海绵组(20例)：采用明胶海绵栓塞治疗。选取标准为新发的肿瘤病人,肿瘤大小不超过l0cm,数目不超过3个,肝功能为A或B级,无远处转移的患者。观察两组1个月后肿瘤大小的变化、甲胎蛋白水平的变化及3、6、12月生存期。注入化疗药及碘油的量跟患者的肝功与肿瘤大小有关,病灶范围大于5cm、肝功能为A级,用碘油lOmg、三氧化二砷30mg,两者混合后在C臂透视下注入。小于5cm的病灶或肝功能为B级减半或减量。KMG栓塞,即先将微球倒入注射器,加生理盐水反复冲洗3次,再加入造影剂跟微球混合,经导管匀速缓慢注射,根据注入栓塞剂的流速及有无反流情况来决定栓塞剂的用量,防止注入过快导致反流。栓塞后再次造影,根据需要可进一步注入栓塞剂直至供血动脉完全栓塞。需要特别指出的是海藻酸钠微球注入时一定要控制着缓慢注入,即刚有反流迹象时就立即停止注入,以防异位栓塞。海绵栓塞,需将海绵剪成颗粒状混合造影剂,注入过程同KMG组。结果两组患者术前资料没有统计学意义(P0.05)；治疗后1个月KMG组有16例肿瘤缩小(80%),对照组有10例肿瘤缩小(50%)；治疗前KMG组有16例AFP高于正常,经治疗后1个月KMG组12例数值下降超过30%(75%),其中5例降到正常水平。对照组AFP有14例高于正常,治疗后7例数值下降超过30%(50%),2例降到正常水平。KMG组和海绵组3、6个月的生存率分别为90%、70%和80%、65%(P值均0.05),1年的生存率分别为50%、30%(P0.05)。结论与明胶海绵相比,海藻酸钠微球栓塞在TACE治疗原发性肝癌中的远期效果更好。
[Abstract]:Primary liver cancer is a common malignant tumor of digestive system. At present, minimally invasive interventional therapy based on TACE has become the main treatment method for advanced liver cancer. TACE mainly inserts catheter selectivity or superselectivity into the target artery of tumor supply. Local chemotherapy with chemotherapeutic drugs and injection of appropriate amount of embolic agent at a suitable speed make the target artery occluded and cause the tumor tissue to be ischemic and necrotic. Embolization plays a very important role in the treatment of liver cancer by TACE, so it is very important to select the suitable embolization agent for the treatment of TACE. Objective to observe the efficacy of sodium alginate microsphere and gelatin sponge in the treatment of primary liver cancer with TACE. Methods 40 patients with primary liver cancer were randomly divided into two groups according to the choice of embolic agent: 20 cases of KMG group were treated with sodium alginate microsphere embolization and 20 cases of sponge group were treated with gelatin sponge embolization. The tumor size was less than 10 cm, the number of tumor was not more than 3, the liver function was grade A or B, and there was no distant metastasis. The changes of tumor size, alpha-fetoprotein level and the survival time of 36 months and 12 months after 1 month in both groups were observed. The amount of chemotherapeutic drugs and lipiodol was related to the liver function and tumor size. The focus was more than 5 cm, liver function was grade A, lipiodol 1 Omg, arsenic trioxide 30 mg, and then injected under C arm fluoroscopy. The focus or liver function less than 5cm was reduced by half or reduced. KMG embolization, that is, the microspheres were poured into the syringe, rinsed with normal saline for 3 times, then mixed with contrast agent and microsphere, and injected slowly through the catheter. The dosage of embolic agent is determined according to the flow rate and reflux of the injected embolizer, so as to prevent the injection of too fast to cause the regurgitation. After embolization, the embolization can be further injected until the feeding artery is completely embolized. It should be pointed out that the injection of sodium alginate microspheres must be controlled by slow injection, that is, the injection should be stopped immediately when there are signs of reflux, in order to prevent ectopic embolism. Sponge embolization, sponge cut into granular mixed contrast agent, injection process the same as KMG group. Results there was no significant difference in preoperative data between the two groups (P 0.05), 16 patients in KMG group had 80 cases of tumor shrinkage one month after treatment, 10 cases in control group had reduced tumor volume 50%, and 16 cases in KMG group had AFP higher than normal before treatment. One month after treatment, the number of 12 cases in KMG group decreased by more than 30 ~ 7575%, among which 5 cases decreased to normal level. In the control group, 14 cases of AFP were higher than normal, 7 cases decreased more than 30%, 2 cases decreased to normal level. KMG group and sponge group, the survival rate at 6 months were 90% and 80% and 0.05%, respectively. The 1 year survival rate was 50% and 30%, respectively. Conclusion compared with gelatin sponge, sodium alginate microsphere embolization is more effective in the treatment of primary liver cancer with TACE.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.7;R730.5

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