经导管肝动脉化疗栓塞术对大肠癌多发肝转移的疗效研究

摘要

目的观察肝动脉介入治疗大肠癌多发肝转移的临床效果及其安全性,探寻一种大肠癌多发肝转移的有效治疗方案.方法选取84例大肠癌多发肝转移患者作为研究对象,并将其随机分为试验组和对照组(每组42例),试验组患者经肝动脉介入给予吡柔比星+丝裂霉素+氟尿嘧啶灌注化疗和吡柔比星+碘化油栓塞治疗,每周治疗一次,四周为一疗程,而对照组给予FAM方案或5-氟尿嘧啶+亚叶酸钙+草酸铂方案全身静脉化疗,三周为一疗程,两组均治疗两个疗程后评价和比较其近期疗效、患者的生活质量、生存情况以及化疗期间不良反应的发生情况.结果治疗后：试验组和对照组患者的近期治疗总有效率分别为73.81%和47.62%,差异有统计学意义(P<0.05)；试验组和对照组患者的生活质量评分分别为(75.00±6.00)和(63.00±5.50),均较治疗前明显升高(P<0.05),且实验组明显高于对照组(P<0.05)；试验组患者的1年、2年和3年生存率分别为59.52%、28.57%和11.90%,而对照组患者分别为85.71%、14.29%和0,虽然其1年生存率显著高于实验组(P<0.05),但2年和3年生存率均显著低于对照组(P<0.05).试验组患者骨髓抑制、胃肠道反应、肝功能异常和发热的发生率均明显低于对照组(P<0.05),但两组之间肾功能异常和口腔溃疡的发生率差异无统计学意义(P>0.05).结论经肝动脉介入进行灌注化疗和栓塞治疗方案治疗大肠癌多发肝转移比常规全身静脉化疗更加有效,且不良反应更少,值得临床推广应用.%Objective To observe the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) in the treatment of multiple liver metastases from colon cancer and set up an effective therapeutic schedule for it. Methods 84 cases with multiple liver metastases from colon cancer were selected and randomly divided into experimental group and control group, 42 cases in each group. The patients in experimental group were given transcatheter arterial infusion with pirarubicin, mitomycin and fluorouracil as well as chemoembolization with pirarubicin and iodized oil once a week, four weeks as a treatment cycle;while the patients in control group were given systemic venous chemotherapy with FAM regimen or 5-fluorouracil, calcium folinatc plus oxaliplatin, a treatment cycle lasted for 3 weeks. The short-term clinical effect, quality of life, survival situation and incidence rates of adverse reactions of two groups were observed and compared after 2 treatment cycles. Results After treatment, the total effective rates of experimental group and control group were respectively 73.81%and 47.62%, which was significantly higher in the experimental group (P<0.05);the quality of life index of experimental group and control group were respectively (75.00± 6.00) and (63.00±5.50) respectively, which was also significantly higher in experimental group (P<0.05);the 1-, 2-and 3-year survival rates of experimental group were respectively 59.52%, 28.57%and 11.90%, respectively in the experimental group, but was 85.71%, 14.29%and 0, the 1-year survival rate of experimental group was significantly lower than that in the control group, but the 2-and 3-year survival rates of experimental group were both significantly higher than those in the control group (P<0.05).The incidence rates of myelosuppression, gastrointestinal reaction, abnormal liver function and fever were all significantly lower than those in the control group (P<0.05), but no significant difference of the incidence rates of abnormal renal function and dental ulcer was found between the two groups (P>0.05). Conclusion TACE was more effective than sys-temic venous chemotherapy in the treatment of multiple liver metastases from colon cancer. It has less adverse reactions and is worth being widely popularized in clinics.