肝动脉栓塞化疗治疗原发.doc

肝动脉栓塞化疗治疗原发性肝癌60例临床疗效分析 专 业：中西医结合临床 研究生：郝明志 导 师：孙伟芬副教授 摘 要 目的 探讨肝动脉栓塞化疗治疗原发性肝癌的疗效并分析影响预后的相关因素。 方法 2002年10月至2003年10月就诊的60例原发性肝癌患者,临床诊断全部符合1990年中国抗癌协会主编《中国常见恶性肿瘤的诊治规范·原发性肝癌》的标准。其中男42例，女18例；年龄26―81岁，平均年龄52岁；AFP阳性45例，Child-Pugh分期为A期者15例,B期者33例,C期者12例;有肝硬化者42例;伴门脉癌栓者11例;影像学诊断为节结型肝癌12例，巨块型肝癌38例，弥漫型肝癌10例。所有病例随访超过6个月。12例作经皮锁骨下动脉穿刺药盒系统（PCS）植入术, 15例行节段性栓塞化疗（S-TOCE）,其余33例行常规肝动脉栓塞化疗（TOCE）;4例行经皮肝穿刺胆管引流术（PTCD）,术后1周行肝动脉栓塞化疗;6例巨块型肝癌经2次栓塞化疗后补充经皮肝穿刺无水酒精注射术（PEI）。25例介入治疗间歇期给予中药生脉注射液60ml静脉滴注qd×15天,干扰素300万U皮下注射qod×30天,其余病例单用干扰素300万U皮下注射qod×30天。 结果 介入治疗2次后12例肿瘤病灶缩小75%以上，20例肿块缩小≥50%，15例肿块缩小≥25%但50%，7例肿块缩小25%， 6例肿块增大。总有效率78.3%。临床分期、是否肝硬化、肿瘤分型对疗效影响较大（P＜0.05）。 结论 肝动脉栓塞化疗是一种可靠、有效的治疗原发性肝癌的手段。患者的临床分期、肿瘤分型以及是否行节段性栓塞化疗对预后影响较大。 主题词： 肝肿瘤 肝动脉/ 化学栓塞，治疗性/ 预后 Retrospective Study:Influence of Transcatheter Hepatic Arterial Chemoembolization on 60 Patients With Primary Hepatocellular Carcinoma Major: Integrated Traditional and Western Medicine Postgraduate: Hao mingzhi Tutor: Prof. Sun weifen [Abstract] Objective To evaluate therapeutic efficacy of primary hepatocellular carcinoma treated with transcatheter oily chemoembolization and analyse correlated elements which effect prognosis. Methods Between October 2002 and November 2003, sixty patients with clinical proven primary HCC treated with TACE(Child-Pugh classification A 15 cases or B 33 cases or C 12 cases,42 patients with liver cirrhosis,11cases with portal vein thrombosis, and in which 38 large HCC or 12 nodular type HCC or 10 permeated type HCC) were included in this study. We compared the survival, tumour volume reduction ratio, variety of serum level of alpha-fetoprotein.And to assess that if clinical stage、tumour type、portal vein thrombosis 、sex or liver cirrhosis affect therapeutic efficacy. Results 12 instances` tumour volume reduction 75% ，20 Instances` tumour volume reduction 50%，15 Instances` tumour volume reduction 25%Yet 50% ，7 instances` reduction 25% ， 6 instances`