术前辅助性肝动脉化疗栓塞对巨块型肝癌预后的影响

发布时间：2018-12-09 16:44

【摘要】：目的:虽然目前原发性肝癌的早期诊断水平有了很大的提高,但原发性肝癌起病隐匿,多数患者就诊时病期已属中、晚期,肿瘤直径已属于大肝癌甚至巨块型肝癌。对于巨块型肝癌,排除手术禁忌后,大多数情况下首选手术治疗。但由于术后复发率高,预后差,因此有必要研究如何改善巨块型肝癌患者的预后。本文通过回顾性分析,追踪随访患者手术切除后肝功能、生存时间等,以对巨块型肝癌术前辅助性经导管肝动脉化疗栓塞术(transcatheter hepatic arterial chemoembolization,TACE)联合降期手术切除与一期手术切除两种治疗方案的疗效进行比较,进而评价术前辅助性肝动脉化疗栓塞对巨块型肝癌预后的影响。方法:对厦门大学附属中山医院肝胆外科在2010年1月至2015年3月期间收住院治疗的通过病理诊断为肝细胞性肝癌的巨块型肝癌31例进行回顾性分析,将其分为术前辅助性TACE治疗联合降期手术组和一期手术组,记录其一般情况、治疗情况及相关临床指标,采用Kaplan-Meier法、Log-Rank检验评价两种治疗方式对预后的影响。结果:通过临床观察和随访,?肝脏肿瘤变化情况:术前辅助性TACE治疗联合降期手术组(n=10例)中有8例予以术前辅助性TACE治疗后肿瘤体积明显缩小者,占80%,其中有6例肿瘤大小由巨块型肝癌降至非巨块型肝癌(10 cm),而有2例予以术前TACE治疗后肿瘤体积较TACE前增大,未出现肿瘤体积无明显变化病例,无术前TACE治疗后出现肝内、肝外转移的病例。术前辅助性TACE治疗联合降期手术组中肿瘤坏死者8例,占80%,其中完全坏死率20%(2/10);而一期手术组肿瘤坏死率4.8%(1/21),无肿瘤完全坏死病例,两组肿瘤坏死率有明显统计学差异(P0.05)。?围手术期情况:术前辅助性TACE治疗联合降期手术组与一期手术组术前肝功能、术后第1天、术后第3天及术后第6天肝功能无明显差异(P0.05)。2组术后均未出现肝功能进一步恶化甚至肝功能衰竭。术前辅助性TACE治疗联合降期手术组病例与一期手术组在手术用时、术中出血量及术后三天腹腔引流管引流量无明显统计学差异(P0.05)。?预后:术前辅助性TACE治疗联合降期手术组与一期手术组生存曲线、无瘤生存曲线相比较其差异有统计学意义(P0.05)。结论:术前辅助性TACE治疗可缩小巨块型肝癌的肿瘤,增加其手术切除的机会,并且可能有助于改善巨块型肝癌手术后的无瘤生存率和总生存率,并不会引起显著的肝功能损害及手术难度的增加,不会延缓手术后的恢复。
[Abstract]:Objective: although the level of early diagnosis of primary liver cancer has been greatly improved at present, the onset of primary liver cancer is hidden, most of the patients were in the middle stage of the disease, and in the late stage, the diameter of the tumor has already belonged to the large liver cancer or even the massive liver cancer. For large-scale liver cancer, surgical treatment is preferred in most cases after surgical taboos are excluded. However, due to the high recurrence rate and poor prognosis, it is necessary to study how to improve the prognosis of massive liver cancer patients. By retrospective analysis, the liver function and survival time after surgical resection were followed up in patients with giant hepatocellular carcinoma (HCC). The objective of this study was to evaluate the hepatic arterial chemoembolization (transcatheter hepatic arterial chemoembolization,) in patients with giant hepatocellular carcinoma before and after operation. To evaluate the effect of preoperative adjuvant hepatic arterial chemoembolization (TACE) on the prognosis of massive hepatocellular carcinoma (HCC). Methods: a retrospective analysis was made on 31 cases of massive hepatocellular carcinoma diagnosed pathologically as hepatocellular carcinoma in the Department of Hepatobiliary surgery, Zhongshan Hospital affiliated to Xiamen University, from January 2010 to March 2015. The patients were divided into two groups: preoperative adjuvant TACE therapy combined with descending operation group and primary operation group. The general situation, treatment status and related clinical indexes were recorded. The influence of two treatment methods on prognosis was evaluated by Kaplan-Meier method and Log-Rank test. Results: through clinical observation and follow-up,? The changes of hepatic tumor: in the preoperative adjuvant TACE therapy combined with descending operation group (n = 10), 8 cases (80%) had tumor volume significantly reduced after preoperative adjuvant TACE treatment. In 6 cases, the tumor size decreased from massive hepatocellular carcinoma to non-giant type liver cancer (10 cm), while in 2 cases after TACE treatment before operation, the tumor volume increased compared with that before TACE. There was no significant change in tumor volume in 6 cases, and no intrahepatic changes occurred after preoperative TACE treatment. Cases of extrahepatic metastasis. There were 8 cases (80%) of tumor necrosis in the preoperative adjuvant TACE therapy combined with descending operation group, in which the complete necrosis rate was 20% (2 / 10). The tumor necrosis rate was 4.8% (1 / 21) in the one-stage operation group, and there was significant difference between the two groups in tumor necrosis rate (P0.05). Perioperative period: preoperative adjuvant TACE therapy combined with reduced phase operation group and primary operation group, liver function before operation, 1 day after operation, There was no significant difference in liver function between the third day and the sixth day after operation (P0.05). There was no further deterioration of liver function or even liver failure after operation in both groups. There was no significant difference in the volume of intraoperative blood loss and the drainage of abdominal cavity drainage between the patients of the preoperative adjuvant TACE group and the first-stage operation group (P 0.05), and there was no significant difference in the volume of intraoperative bleeding and the drainage volume of the peritoneal drainage tube 3 days after operation between the two groups (P0.05). Prognosis: there was significant difference in survival curve and tumor-free survival curve between preoperative adjuvant TACE therapy combined with operation group and one-stage operation group (P0.05). Conclusion: preoperative adjuvant TACE therapy can reduce the tumor size and increase the chance of resection, and may help to improve the tumor-free survival rate and overall survival rate. It does not cause significant damage to liver function and increase the difficulty of operation, and does not delay the recovery after operation.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.7

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