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1、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刀至2003年10刀就诊的60例原发性肝癌患者,临床诊断全部符合1990年屮国抗癌协会主编《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;冇肝硕化者42例;伴门脉癌栓者11例;影像学诊断为节结型肝癌12例,巨
2、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-T0CE),其余33例行常规肝动脉栓塞化疗(T0CE);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(PE1)。25例介入治疗间歇期给予中约生脉注射液60ml静脉滴注qdX15天,干扰素300刀°皮下注射q°dX30天,其余病例单用干扰素300万^皮下注射qo(!X30天。结果介入治疗2次后12例肿瘤病灶缩小75%以上,2
3、0例肿块缩小$50%,15例肿块缩小225%但〈50%,7例肿块缩小<25%,6例肿块增大。总有效率78.3%o临床分期、是否肝硕化、肿瘤分型对疗效影响较大(PV0.05)。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/病理学肝动脉/药物作用化学栓塞,治疗性/方法预后RetrospectiveStudy:InfluenceofTranscatheterHepaticArterialChemoembolizationon60PatientsWith
4、PrimaryHepatocellularCarcinomaMajor:IntegratedTraditionalandWesternMedicinePostgraduate:HaomingzhiTutor:Prof・Sunweifen[Abstract]ObjectiveToevaluatetherapeuticefficacyofprimaryhepatocel1ularcareinomatreatedwithtranscatheteroilychemoembolizationandanalysecorrelatedelements
5、whicheffectprognosis.MethodsBetweenOctober2002andNovember2003,sixtypatientswithclinicalprovenprimaryHCCtreatedwithTACE(Chi1d-PughclassificationA15casesorB33casesorC12cases,42patientswith1ivercirrhosis,1leaseswithportalveinthrombosis,andinwhich38largeIICCor12noduleirtypeI
6、ICCor10permeatedtypeHCC)wereincludedinthisstudy.Wecomparedthesurvival,tumourvolumereductionratio,varietyofserumlevelofalpha-fetoprotein.Andtoassessthatifclinicalstage^tumourtype^portalveinthrombosis、sexorlivercirrhosisaffecttherapeuticefficacy.ResuIts12instances'tumourvo
7、lumereduction>75%,20Instances'tumourvolumereduction>50%,15Instances'tumourvolumereduction〉25%Yet<50%,7instancesreduction〈25%,6instancesisbroadend•Sexorportaiveinthrombosisdidnotaffecttherapeuticefficacy(P>0.05)butclinicalstagc>tumourtypc、orlivercirrhosishadeffects(P<0.05
8、.Fortyonecases"serumlevelofalpha-fetoproteinbecamelower,whichtumourvolumebecamesmall,too.Conclusioninte