肝癌术中丝裂霉素纤维蛋白胶局部缓释化疗的应用效果研究

摘要

目的 探讨肝癌术中丝裂霉素纤维蛋白胶局部缓释化疗的应用效果.方法 选取2007年7月-2009年6月我院收治的具有手术指征的肝癌患者30例,随机分为观察组和对照组,每组15例.对照组患者行单纯手术治疗,观察组患者在瘤体切除后的手术创面喷涂丝裂霉素纤维蛋白胶2.5 ml进行局部缓释化疗.观察两组患者术前及术后1个月、3个月、6个月、1年肝功能指标,血清甲胎蛋白(AFP)水平及凝血酶原时间(PT);记录两组患者中位无瘤生存期,计算1、2、3年无瘤生存率;建立Cox风险回归模型分析肝癌术后复发的影响因素.结果 两组患者术前肝功能指标、血清AFP水平及PT比较,差异均无统计学意义(P＞0.05);两组术后1个月、3个月、6个月、1年血清AFP水平比较,差异均有统计学意义(P＜0.05),两组肝功能指标、PT比较,差异均无统计学意义(P＞0.05).对照组中位无瘤生存期为15.5个月[95%CI(13.9,17.6)],观察组为21.3个月[95%CI(2.4,28.2)],两组比较差异有统计学意义(χ2=6.190,P＜0.05);对照组1、2、3年无瘤生存率分别为62.2%、40.4%及12.7%,观察组分别为81.3%、54.6%及30.7%,两组比较差异均有统计学意义(χ2值分别为4.013、4.267、4.826,P＜0.05).Cox风险回归模型显示,术中缓释化疗、肿瘤结节数目对Cox风险回归模型的影响有统计学意义(P＜0.05).结论 肝癌术中应用丝裂霉素纤维蛋白胶局部缓释化疗可明显延长患者无瘤生存期,降低术后血清AFP水平,对肝功能无明显影响.%Objective To explore the effect of local sustained - release chemotherapy by fibrin glue enwrapping mitomycin in hepatectomy operation. Methods Thirty liver cancer patients admitted from July 2007 to Jane 2009 were divided randomly into groups observation and control, 15 in each. Control group were given only surgical treatment, observation group given local sustained - release chemotherapy by fibrin glue enwrapping mitomycin ( 2. 5 ml ) after removal of tumors. Liver function indicators , serum alpha - fetoprotein ( AFP ) level, prothrombin time ( PT ) were observed before operation and 1 , 3 , 6, 12 months after operation; Median tumor - free survival time recorded; 1 - , 2 - , 3 - year tumor - free survival rates calculated. Recurrence influencing factors were analyzed by Cox hazard regression model. Results There was no significant difference in liver function indicators, serum AFP level, PT between the two groups before operation ( P > 0. 05 ), but there was in serum AFP level 1, 3 , 6 , 12 months after operation ( P <0. 05 ), not in liver function indicators or PT ( P > 0. 05 ). The median tumor -free survival time was 15. 5 months in control group [ 95% CI ( 13. 9, 17. 6 ) ], 21. 3 months in observation group [ 95% CI ( 2. 4, 28. 2 ) ], the difference was significant ( x2 = 6. 190, P < 0. 05 ); the 1 - , 2 - , 3 - year tumor - free survival rates were 62. 2% , 40. 4% , 12. 7% , respectively in control group, 81. 3% , 54. 6% , 30. 7% , respectively in observation group, the differences was all significant ( x2 = 4. 013 , 4. 267 , 4. 826, P <0. 05 ). By Cox hazard regression model, the influence of intraoperative sustained - release chemotherapy, number of tumor nodules on Cox hazard regression model was significant ( P < 0. 05 ). Conclusion Sustained - release chemotherapy by fibrin glue enwrapping mitomycin in hepatectomy operation, delaying early recurrence of hepatocellular carcinomas and decreasing serum AFP, has no significant effect on liver function.