2019肝动脉栓塞化疗联合中药治疗原发性肝癌的疗效观察.doc
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1、DOC格式论文,方便您的复制修改删减肝动脉栓塞化疗联合中药治疗原发性肝癌的疗效观察(作者:_单位: _邮编: _) 【摘要】 目的 评价肝动脉栓塞化疗(transcatheter hepatic arterial chemoembolization, TACE)联合中药治疗在肝癌中临床价值。方法 我科自2005年5月2007年10月,共62例肝癌患者接受肝动脉栓塞化疗。所有患者被随机分为两组,其中研究组38例,在介入治疗的同期或前后服用中药治疗,对照组24例,仅接受肝动脉栓塞化疗。所有患者均接受2个或2个以上疗程的TACE术,术后定期随访。根据实体瘤的临床疗效评价标准,2个疗程TACE治疗后进
2、行临床疗效评价。结果 2个疗程TACE术后1个月复查CT评价临床疗效,完全缓解(CR) 3例,部分缓解(PR) 43例,稳定(SD) 12例,进展(PD) 4例,其中研究组CR 2例,PR 30例,SD 4例,PD 2例,对照组CR 1例,PR 13例,SD 8例,PD 2例。中位随访时间11.3个月,1年生存率为67.7%(42/62),研究组和对照组1年生存率分别为73.7%(28/38)和58.3%(14/24)。治疗过程中大多数毒性都是轻微、一过性的,随访过程中并未发现严重不良事件。在度的毒性方面,研究组显著低于对照组。结论 肝动脉栓塞化疗联合中药治疗肝癌能显著提高临床疗效,同时降低不
3、良反应的发生率及程度。 【关键词】 原发性肝癌;肝动脉栓塞化疗;中药A clinical observation of transcatheter hepatic arterial chemoembolization combined with Chinese materia medica for Primary Liver Cancer 【Abstract】 Objective To investigate the clinical value of transcatheter hepatic arterial chemoembolization (TACE) combined with C
4、hinese materia medica for primary liver cancer.Methods From May 2005 to October 2007, a total of 62 patients with primary liver cancer were received TACE. 38 patients with primary liver cancer were assigned to receive TACE combined with Chinese materia medica (experimental group), while another 24 p
5、atients were received TACE alone (control group). The effects were evaluated after 2 cycles of TACE according to response evaluation criteria in solid tumors.Results One month after 2 cycles of TACE, computer tomography was carried out to evaluate the response. Complete response (CR) was achieved in
6、 3 of 62 evaluable patients, 43 had partial response (PR), 12 had stable disease (SD) and 4 had progressive disease (PD). In experimental group, CR was seen in 2 patients, PR in 30 patients, SD in 4 patients and PD in 2 patients. While in control group, CR was seen in 1 patient, PR in 13 patients, S
7、D in 8 patients and PD in 2 patients. With a median follow-up of 11.3 months, 1-year overall survival rate was 67.7% (42/62), 73.7% (28/38) in experimental group and 58.3% (14/24) in control group. During the follow-up periods, most toxicity was low-grade and transient and clinically significant adv
8、erse event was not observed. The grade 3-4 toxicity during treatments in experimental group was lower than that in control group.Conclusion TACE combined with Chinese materia medica is more effective than TACE alone for primary liver cancer with lower adverse reactions. 【Key words】 Primary liver can
9、cer; transcatheter hepatic arterial chemoembolization;Chinese materia medica 目前肝癌首选的治疗方法仍是手术切除,但由于肝癌起病隐匿,患者早期常无症状,而多数患者确诊为肝癌时已为中晚期,丧失了手术机会,能手术切除者仅占10 %15 %。肝动脉栓塞化疗(TACE) 是丧失手术机会或无法手术切除的中、晚期肝癌患者首选治疗方法。中药因能减毒增效,提高肝癌介入治疗效果,提升患者生活质量而倍受关注 1。最近,笔者总结了我科在应用肝动脉栓塞化疗联合中药治疗对肝癌患者的临床疗效,现就其使用方法、安全性和近期疗效等方面进行评价,报道如
10、下。 1 资料与方法 1.1 病例资料 所选病例全部按卫生部肝细胞肝癌的诊治规范,经行肝穿刺活检病理组织学确诊,或影像学(超声加CT或MR)配合肿瘤标记物(AFP、CEA、CA19-9 等)检查而确诊。所有病例均满足以下条件:未合并有严重的心、肝、肾功能损害;血液学检查无栓塞化疗禁忌;治疗前无黄疸、腹水、恶液质或脑转移等表现;无下腔静脉或门静脉癌栓形成;无明显肝动、静脉瘘形成; 均不适宜手术治疗或无明显手术指征。 收集从2005年5月2007年10月在我科接受肝动脉栓塞化疗的原发性肝癌患者临床资料,共62例患者,男40例,女22例;年龄3172岁,中位年龄45岁。其中巨块型肝癌45例,结节型肝
11、癌17例。肝功能Child 分级:A 级48例,B 级11例,C 级3例。根据是否接受中药治疗,分为联合中药治疗的研究组(38例) 和单纯应用介入治疗的对照组(24例),两组上述一般临床资料差异均无显著性(P0.05) ,两组患者一般临床资料比较见表1。 表1 两组患者一般临床资料比较 1.2 肝动脉栓塞化疗 全部病例均接受TACE 治疗2 次或2次以上,每次间隔45周。采用改良Seldinger 方法,在DSA 引导下,经股动脉穿刺插管至肝固有动脉或其分支后造影,观察肿瘤染色、供应肿瘤血管以及是否有血管变异等情况。化疗药物选择为氟尿嘧啶、丝裂毒素、羟基喜树碱、阿霉素或吡喃阿霉素等,以上药物2
12、3联,灌注上述药物时用生理盐水稀释成40%50%的溶液,经导管缓慢注入。碘化油1030ml一般与阿霉素充分混合成乳剂后缓缓注入。最后用12mm的明胶海绵栓塞肝癌供血动脉。根据患者的情况,34周后复查血常规、肝肾功能、心电图等而决定是否继续行TACE治疗。所有患者均密切随访,2个疗程TACE治疗后1个月复查CT进行临床疗效评价以进行统计学分析。 1.3 中药治疗 研究组在介入的过程中进行中医辨证治疗,术后随症加减,中药采用扶正解毒方加减。扶正解毒汤基本方:党参、茯苓、白术、白花蛇舌草、半枝莲、赤芍、柴胡、茵陈等。随症加减:恶心呕吐者加竹茹、姜半夏、旋覆花;胁腹痛加重者加元胡、香附、莪术;纳差者加
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- 2019 动脉 栓塞 化疗 联合 中药 治疗 原发性 肝癌 疗效 观察
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