TACE及TACE联合PEI、RF治疗肝脏转移癌疗效比较.doc

TACE及TACE联合PEI、RF治疗肝脏转移癌疗效比较 　 作者：王庆良 郭依廷 刘海燕 【摘要】目的：评价肝动脉化疗栓塞（TACE）与TACE联合经皮无水乙醇注射（PEI）或射频消融（RF）治疗肝脏转移癌的不同临床疗效。方法：67例肝转移癌分为单纯TACE组46例和联合治疗组21例（其中联合PEI组7例，联合RF组14例）。两组治疗结束后通过随访、CT复查及血液分析进行评价。结果：单纯TACE组的肿瘤总缩小率和肿瘤完全坏死率分别为46.8%和20.7%，联合治疗组分别为78.9%、49.2%（P均＜0.05），单病灶组、无转移灶组及联合治疗组的2年生存率高于多病灶组、有转移组和单纯TACE组（P均＜0.05）。结论：综合介入治疗转移性肝癌较单纯TACE可以使病灶得到有效控制，减少肿瘤的复发或转移，延长患者的生存期。 【关键词】肝肿瘤#12539;肝动脉#12539;栓塞，治疗性#12539;乙醇#12539;射频消融 Comparison of the effect of TACE and TACE combined with PEI and RF on liver metastasis 【ABSTRACT】Objective:To evaluate the different effect of TACE and TACE combined with PEI and RF in treating liver metastasis.Methods：67 patients with liver metastasis were classified as group TACE(46 cases)and combined group including TACE+PEI(7 cases) and group TACE+RF(14 cases).All patients were analyzed after treatment by followup、CT and their blood biochemical tests.Results:The rate of tumor shrinkage and necrosis was 46.8% and 20.7%,while the contrast group was 78.9%,49.2% respectively(P＜0.05).There were significant difference(P＜0.05)for 2year survival rate in singlelesion group,nondistant metastasis group and combinedtherapy group.Conclusion:Comprehensive interventional therapy is effective in controlling lesions enlargement,reducing recurrent or distant metastasis and prolonging patients life in liver metastasis. 【KEY WORDS】Liver neoplasms#12539;Hepatic artery#12539;Embolization,therapeutic#12539;Ethanol#12539;Radiofrequency ablation 肝脏是恶性肿瘤转移最易受累的器官之一，肝转移癌能手术切除者不到20%［1］，但大多数肝转移癌患者介入治疗可以获得较理想的治疗效果，为了探索提高介入治疗效果的方法，今将肝动脉化疗栓塞（TACE）联合经皮无水乙醇注射（PEI）或射频消融（RF）与单纯TACE的疗效进行对比观察，现报告如下。 1 材料与方法 1.1 一般资料 住院治疗肝转移癌67例，男39例，女28例，年龄36~75岁，平均55.3岁。67例原发灶来自结肠癌20例，食管癌17例，胃癌13例，胰腺癌6例，鼻烟癌和肺癌各3例，恶性胸腺瘤和乳腺癌各2例，前列腺癌1例。所有患者均经强化CT和/或MRI明确诊断，病灶直径为1.8~11.8cm，单病灶者12例，2个病灶者9例，3个以上病灶者46例。5例合并骨转移，17例伴纵隔淋巴结转移，5例合并肺转移。 1.2 方法 1.2.1 单纯TACE 采用Seldinger技术穿刺右侧股动脉，选择性插管分别至腹腔干动脉及肠系膜上动脉，高压注射造影剂进行动脉及门静脉造影，观察肝脏内病灶的供血状况，然后进行超选择插管至肿瘤供血动脉，经导管器次灌注化疗药物表阿霉素60~80mg，羟基喜树碱30mg，方克1600~2000mg，顺铂80~100mg（取其中3种药物组