经肝动脉化疗栓塞术联合门静脉内125I粒子植入治疗原发性肝癌合并门静脉癌栓的效果观察

王巧瑜; 潘洁; 周元敏

doi:10.3969/j.issn.1001-5256.2018.01.028

经肝动脉化疗栓塞术联合门静脉内125I粒子植入治疗原发性肝癌合并门静脉癌栓的效果观察

DOI: 10.3969/j.issn.1001-5256.2018.01.028

广州市第十二人民医院内五科

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中图分类号: R735.7
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出版历程
- 出版日期: 2018-01-20

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

Fifth Department of Internal Medicine, Guangzhou No.12 People′s Hospital, Guangzhou 510610, China

摘要

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....
- 肝肿瘤 /
- 化学栓塞,治疗性 /
- 碘放射性同位素 /
- 治疗结果
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.
- liver neoplasms /
- chemoembolization, therapeutic /
- iodine radioisotopes /
- treatment outcome

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参考文献(17)

[1]ZHENG RS, ZUO TT, ZENG HM, et al.Mortality and survival analysis of liver cancer in China[J].Chin J Oncol, 2015, 5 (9) :697-702. (in Chinese) 郑荣寿, 左婷婷, 曾红梅, 等.中国肝癌死亡状况与生存分析[J].中华肿瘤杂志, 2015, 5 (9) :697-702.

[2]Chinese Society of Liver Cancer, Chinese Anti-Cancer Association;Liver Cancer Study Group, Chinese Society of Hepatology, Chinese Medical Association;Chinese Society of Pathology, Chinese Anti-Cancer Association, et al.Evidence-based practice guidelines for the standardized pathological diagnosis of primary liver cancer in China (2015 update) [J].J Clin Hepatol, 2015, 31 (6) :833-839. (in Chinese) 中国抗癌协会肝癌专业委员会, 中华医学会肝病会分会肝癌学组, 中国抗癌协会病理专业委员会, 等.原发性肝癌规范化病理诊断指南 (2015年版) [J].临床肝胆病杂志, 2015, 31 (6) :833-839.

[3]FANG ZX, CHENG D, FANG ZH, et al.Evaluation of transcatheter arterial chemoembolization combined with radiofrequency ablation in the treatment of large hepatocellular carcinoma[J/CD].Chin J Clinicians:Electronic Edition, 2012, 6 (10) :2823-2825. (in Chinese) 方志雄, 程丹, 方志宏, 等.肝动脉化疗栓塞联合射频消融治疗大肝癌疗效评价[J/CD].中华临床医师杂志:电子版, 2012, 6 (10) :2823-2825.

[4]ZOU ZQ, WU ZQ, WANG Y, et al.A case of right hepatocellular carcinoma with inferior vena cava tumor thrombus detected by transesophageal echocardiography[J].Natl Med J China, 2016, 96 (37) :3026-3027. (in Chinese) 邹志清, 吴周全, 王勇, 等.经食管心脏超声检测右肝癌合并下腔静脉癌栓患者一例[J].中华医学杂志, 2016, 96 (37) :3026-3027.

[5]SUN SM, HU JF, YANG DX, et al.Comparison of sensitivity and accuracy CT and MRI in the diagnosis of liver cancer[J].Pract J Cancer, 2015, 5 (12) :1896-1898. (in Chinese) 孙世明, 胡金发, 杨大兴, 等.CT和MRI对肝癌合并癌栓诊断中的敏感性和准确性对比研究[J].实用癌症杂志, 2015, 5 (12) :1896-1898.

[6]KIM CJ, KIM HJ, PARK JH, et al.Radiologic response to transcatheter hepatic arterial chemoembolization and clinical outcomes in patients with hepatocellular carcinoma[J].Liver Int, 2014, 34 (2) :305-312.

[7]HUANG L, QI L, LI G.Therapeutic effect and prognostic analysis of intensity-modulated radiotherapy for primary hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus[J].J Clin Hepatol, 2015, 31 (6) :891-894. (in Chinese) 黄龙, 祁亮, 黎功.原发性肝癌合并门静脉及下腔静脉癌栓调强放疗的疗效及预后分析[J].临床肝胆病杂志, 2015, 31 (6) :891-894.

[8]ZHU XL.Comprehensive interventional treatment of hepatocellular carcinoma with portal vein tumor thrombosis[J].J Clin Hepatol, 2015, 31 (6) :863-869. (in Chinese) 朱晓黎.肝细胞癌伴门静脉癌栓的介入综合治疗[J].临床肝胆病杂志, 2015, 31 (6) :863-869.

[9]HUANG WS, CAI MY, ZENG ZL, et al.Transarterial chemoembolization combined with CT-guided125I seed implantation for the treatment of hepatocellular carcinoma associated with portal vein tumor thrombus[J].J Intervent Radiol, 2015, 24 (6) :488-493. (in Chinese) 黄文薮, 蔡明岳, 曾昭吝, 等.TACE联合125I放射性粒子植入治疗肝细胞癌门静脉癌栓[J].介入放射学杂志, 2015, 24 (6) :488-493.

[10]REN YQ, CAO JB, HAN JQ, et al.Clinical efficacy of stent implantation combined with trans-arterial chemoembolization for primary hepatic carcinoma with portal vein and inferior vena cava tumor thrombus[J].Beijing Med J, 2015, 37 (3) :224-227. (in Chinese) 任永强, 曹建彪, 韩聚强, 等.支架置入联合肝动脉化疗栓塞术对原发性肝癌伴门静脉或下腔静脉癌栓的临床疗效[J].北京医学, 2015, 37 (3) :224-227.

[11]SHAN CS, WANG S, YU CP, et al.Portal vein stenting combined with linear125I seed strand implantation and TACE for treatment of hepatocellular carcinoma with portal vein tumor thrombus[J].Chin J Med Imaging Technol, 2015, 31 (3) :429-433. (in Chinese) 单长胜, 王松, 于春鹏, 等.门静脉支架同步125I粒子条植入联合经导管动脉化疗栓塞术治疗肝癌伴门静脉癌栓[J].中国医学影像技术, 2015, 31 (3) :429-433.

[12]YU RA, LIU J, LE Y, et al.Surgical resection plus transcatheter arterial chemoembolization for advanced hepatocellular carcinoma with portal vein tumor thrombus:an analysis of therapeutic efficacy[J].Chin J Gen Surg, 2015, 24 (7) :933-938. (in Chinese) 俞礽爱, 刘佳, 乐弈, 等.外科手术联合TACE治疗晚期肝癌合并门静脉癌栓的疗效分析[J].中国普通外科杂志, 2015, 24 (7) :933-938.

[13]JIANG HZ, DENG X, ZHONG YF.TACE treatment for liver cancer with portal vein tumor thrombus[J].Chin J Gen Surg, 2015, 24 (1) :116-120. (in Chinese) 江海中, 邓新, 钟永富.肝癌合并门静脉癌栓的TACE治疗[J].中国普通外科杂志, 2015, 24 (1) :116-120.

[14]ZHANG W, SONG TQ, ZHANG T, et al.Adjuvant interferon forearly or late recurrence of hepatocellular carcinoma and mortality from hepatocellular carcinoma following curative treatment:a meta-analysis with comparison of different types of hepatitis[J].Mol Clin Oncol, 2014, 2 (6) :1125-1134.

[15]SHAO HB, MA TC, NIU M, et al.Endovascular placement of iodine-125 seed strand combined with chemoembolization for the treatment of hepatocellular car-cinoma with tumor thrombus in portal vein[J].Chin J Med Offic, 2016, 44 (4) :377-381. (in Chinese) 邵海波, 马腾闯, 牛猛, 等.碘125粒子联合肝动脉化疗栓塞术治疗原发性肝癌合并门脉分支癌栓疗效分析[J].临床军医杂志, 2016, 44 (4) :377-381.

[16] YANG X, YUAN GB, WANG YC, et al.Clinical value of125I seeds implantation combined with high intensity focused ultrasound for the treatment of portal vein tumor thrombus from hepatocellular carcinoma[J].Chin J Nucl Med Mol Imaging, 2015, 35 (3) :182-185. (in Chinese) 杨鑫, 袁耿彪, 王玉婵, 等.125I粒子植入联合高强度聚焦超声治疗肝癌门静脉癌栓的临床价值[J].中华核医学与分子影像杂志, 2015, 35 (3) :182-185.

[17]WU JP, HE DF.Evaluation the efifcacy of125I seed strand implantation for treatment of hepatocellular carcinoma with main portal vein tumor thrombus[J/CD].Chin J Inter Rad:Electronic Edition, 2015, 3 (3) :144-147. (in Chinese) 武京鹏, 何东风.125I粒子条植入治疗原发性肝癌伴门静脉主干癌栓的近期疗效[J/CD].中华介入放射学杂志:电子版, 2015, 3 (3) :144-147.

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