TACE联合SPVE治疗在肝癌二期切除术中的应用价值

摘要

Objective To investigate the clinical application value of liver transarterial chemoembolization (TACE) combined with selective portal vein embolization (SPVE) in the treatment of two stage hepatectomy.Methods From January 2010 to December 2013,120 patients with liver tumors who were not suitable for one stage hepatectomy admitted to our department were enrolled in this study.Among them,60 (control group) received TACE therapy and 60 (observation group) accepted TACE combined with SPVE treatment.The liver function,liver volume change,the second stage resection,survival rate,complication and adverse reaction were compared between the two groups after treatment,and the application value of the therapy was analyzed.Results All the patients were successfully completed the treatment.The aspartate aminotransferase (AST),alanine aminotransferase (ALT),and total bilirubin (TB) of the two groups were all recovered to the pre-treatment level on the 7th day after treatment,and there was no statistical difference between the two groups (P ＞ 0.05).Except for the 6th months,the survival rates of the observation group in 12th months,18 months and 24 months were all higher than those in the control group.The liver volume of the control group and the observation group increased to varying degrees,and the tumor volume showed varying degrees of atrophy.The residual liver volume (RLV) of the observation group was (527.29 ±58.69) cm3,which was increased and higher than the control group before the treatment (P ＜ 0.05).The implementation rate of the second stage operation was also higher than that of the control group (P ＜ 0.05).There were no serious complications in the two groups,and there was no significant difference between the two groups about adverse reactions (P ＞ 0.05).Conclusions The treatment of TACE combined with SPVE can effectively control tumor growth,increase RLV,so as to improve the resection rate and survival rate of patients with primary hepatectomy who can not undergo primary resection.%目的 探讨经肝动脉化学疗法栓塞(TACE)联合选择性门静脉栓塞(SPVE)治疗在肝癌二期切除术中的应用价值.方法 以2010年1月至2013年12月本院收治的120例不能开展一期手术切除的原发性肝癌患者为研究对象(观察组和对照组各60例),对照组实行TACE治疗,观察组实行TACE联合SPVE治疗.比较治疗后两组间的肝功能、肝脏体积变化、二期手术切除实施情况、生存率以及并发症和不良反应,分析该治疗方法的应用价值.结果 所有患者均顺利完成了治疗,两组患者的谷草转氨酶(AST)、谷丙转氨酶(ALT)、总胆红素(TB)在治疗后第7天均恢复到治疗前水平,两组间差异无统计学意义(P＞0.05).除第6个月外,观察组在第12、18、24个月的生存率均高于对照组.对照组和观察组患者的肝脏体积出现了不同程度的增大,肿瘤体积均出现了不同程度的萎缩,观察组的预计残余肝体积(RLV)为(527.29±58.69) cm3,比治疗前增加且高于对照组(P＜0.05),其二期手术切除实施率也高于对照组(P＜0.05).两组均未出现严重的并发症,两组间不良反应情况差异无统计学意义(P＞0.05).结论 对于不能开展一期手术切除的肝癌患者采用TACE联合SPVE治疗,能有效控制肿瘤生长,增加RLV,提高二期手术切除率和生存率.