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目的探讨三丙烯微球联合经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)在巨块型肝癌介入治疗中的临床价值。方法选择2011年2月—2013年3月收治的行三丙烯微球联合TACE治疗的36例巨块型肝癌患者作为研究对象,患者分别在6个月内行1~4次介入治疗,末次治疗4周后行多层螺旋CT(multiple slice computed tomography,MSCT)检查。记录分析临床疗效及栓塞相关不良反应发生情况。结果 36例患者共行介入治疗112次,完全缓解4例,占11.1%;部分缓解25例,占69.4%;稳定4例,占11.1%;进展3例,占8.3%。总有效率为80.6%(29/36),临床受益率为91.7%(33/36),9个月、1年总生存率分别为91.7%(33/36)、83.3%(30/36)。患者术后24~72 h均出现不同程度的栓塞综合征症状如恶心、呕吐、腹痛、发热等。出现顽固性呃逆1例,胸腔积液3例,经对症治疗后好转。本组最常见的药物不良反应为骨髓抑制作用,Ⅲ(Ⅳ)级白细胞减少9例,占25.0%;中性粒细胞下降6例,占16.7%;血小板下降3例,占8.3%,以上不良反应经对症处理后均明显改善,未发生毒性相关死亡。结论三丙烯微球联合TACE方案治疗巨块型肝癌疗效安全可靠,具有较大临床价值。
Objective To investigate the clinical value of transcatheter arterial chemoembolization (TACE) in the interventional treatment of massive liver cancer. Methods Twenty-six patients with giant hepatocellular carcinoma who underwent TACE treatment from February 2011 to March 2013 were enrolled in this study. Patients were treated with 1 to 4 interventions within 6 months and 4 Weeks after the multi-slice spiral CT (multiple slice computed tomography, MSCT) examination. Record the clinical efficacy and incidence of embolism-related adverse reactions. Results Thirty-six patients underwent interventional therapy 112 times, with complete remission in 4 cases (11.1%), partial remission in 25 cases (69.4%), stabilization in 4 cases (11.1%) and progression in 3 cases (8.3%). The total effective rate was 91.7% (33/36), 91.7% (33/36) and 83.3% (30/36), respectively. The overall effective rate was 80.6% (29/36) . Patients with signs of embolism syndrome such as nausea, vomiting, abdominal pain, fever and so on occurred in 24-72 h after operation. 1 cases of intractable hiccups, 3 cases of pleural effusion, improved after symptomatic treatment. The most common adverse drug reaction in this group was myelosuppression. Grade III (Ⅳ) leukopenia was found in 9 (25.0%); neutrophil decreased in 6 (16.7%); thrombocytopenia was found in 3 (8.3%); Response after symptomatic treatment were significantly improved, no toxic-related deaths. Conclusion Tropslon microspheres combined with TACE regimen for the treatment of massive liver cancer is safe and reliable, with great clinical value.