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Clinical effect of transarterial chemoembolization combined with endovascular implantation of iodine-125 seeds in treatment of primary liver cancer complicated by portal vein tumor thrombus
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摘要:
目的探讨经肝动脉化疗栓塞术（TACE）联合门静脉内125I粒子植入技术治疗原发性肝癌合并门静脉癌栓（PVTT）患者的效果及对肝功能的影响。方法回顾性分析2013年1月-2016年12月广州市第十二人民医院收治的96例原发性肝癌合并PVTT患者临床资料,其中52例患者采取TACE+门静脉腔内放射性125I粒子植入治疗（联合组）,44例患者仅采取了TACE治疗（对照组）,对比两组患者肿瘤病灶、PVTT的治疗效果,以及治疗前后相关实验室指标的变化。计量资料两组间比较采用t检验;计数资料组间比较采用χ2检验。结果联合组的肿瘤病灶缓解率（59.62%vs 38.64%）、PVTT缓解率（80.77%vs 59.09%）高于对照组,差异均有统计学意义（χ2值分别为4.196、5.421,P值分别为0.041、0.020）。术后8周,联合组患者的血清AFP、门静脉主干直径、PLT测定值均低于对照组,血清ALT、AST、TBil水平均高于对照组,差异均有统计学意义（t值分别为3.891、3.291、2.330、3....
Abstract:Objective To investigate the clinical effect of transarterial chemoembolization ( TACE) combined with endovascular implantation of iodine-125 seeds in the treatment of primary liver cancer complicated by portal vein tumor thrombus ( PVTT) and its influence on liver function. Methods A retrospective analysis was performed for the clinical data of 96 patients with primary liver cancer complicated by PVTT who were admitted to Guangzhou No. 12 People's Hospital from January 2013 to December 2016. Among these patients, 52 were treated with TACE combined with endovascular implantation of iodine-125 seeds in the portal vein ( combination group) and 44 were treated with TACE alone ( control group) . The two groups were compared in terms of the outcome of tumor lesions and PVTT and the changes in related laboratory markers after treatment. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the control group, the combination group had significantly higher remission rates of tumor lesions ( 59. 62% vs 38. 64% , χ2= 4. 196, P = 0. 041) and PVTT ( 80. 77% vs 59. 09% , χ2=5. 421, P = 0. 020) . At 8 weeks after surgery, the combination group had significantly lower serum alpha-fetoprotein ( AFP) , diameter of the main portal vein, and platelet count ( PLT) and significantly higher serum levels of alanine aminotransferase ( ALT) , aspartate aminotransferase ( AST) , and total bilirubin ( TBil) than the control group ( t = 3. 891, 3. 291, 2. 330, 3. 729, 3. 582, and 4. 126, all P <0. 05) ; both groups showed significant increases in serum levels of ALT, AST, and TBil ( all P < 0. 05) and significant reductions in PLT, serum AFP and diameter of the main portal vein ( all P < 0. 05) . Conclusion TACE combined with endovascular implantation of iodine-125 seeds in the portal vein has a better clinical effect than TACE alone in the treatment of primary liver cancer complicated by PVTT, but more attention should be paid to liver impairment during treatment.
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