结肠癌术后行经导管肝动脉化疗栓塞联合区域灌注化疗对预后的影响

摘要

目的：探讨结肠癌术后行经导管肝动脉化疗栓塞（ TACE）联合区域灌注化疗对预后的影响。方法将2007年7月至2010年7月淄博市淄川区医院收治的90例结肠癌术后发生肝转移患者按照抽签方法随机分为全身化疗组和 TACE 联合区域灌注化疗组，各45例。全身化疗组给予500 mg 氟尿嘧啶＋40 mg顺铂静脉全身给药，TACE联合区域灌注化疗组先给予500 mg氟尿嘧啶＋40 mg顺铂灌注给药，后使用超液态碘油2～3 mL加羟基喜树碱注射液10 mg。比较两组患者的治疗效果、治疗前后免疫功能变化、不良反应和随访情况。结果①TACE联合区域灌注化疗组甲胎蛋白及肝内转移灶体积均显著小于全身化疗组[（56±4）μg／L 比（290±25）μg／L，（22±4） cm3比（45±9） cm3，P＜0.01]；②TACE 联合区域灌注化疗组治疗后 CD3＋、CD4＋、CD4＋／CD8＋、CD16＋CD56＋显著高于治疗前（P＜0.05），且TACE联合区域灌注化疗组CD3＋、CD4＋、CD4＋／CD8＋高于全身化疗组[（74±10）％比（62±4）％，（44±10）％比（31±7）％，（2.7±0.6）比（1.3±0.4），P ＜0.01]；③两组不良反应发生率比较差异无统计学意义（P＞0.05）；④全身化疗组2、3年生存率显著低于TACE 联合区域灌注化疗组（44.4％比66.7％、26.7％比51.1％），差异有统计学意义（ P ＜0.05）。结论 TACE联合区域灌注化疗可有效预防结肠癌术后肝转移，且可提高患者的总生存率。%Objective To explore the influence of hepatic transcatheter arterial chemoembolization (TACE) combined with local infusion chemotherapy on the prognosis.Methods A total of 90 cases of colon cancer with liver metastases in Zibo City Zichuan District Hospital from Jul .2007 to Jul.2010 were randomly divided into systemic chemotherapy group(500 mg fluorouracil +40 mg cisplatin,intravenous) and local chemotherapy combined with TACE group ( 500 mg fluorouracil +40 mg cisplatin infusion, super liquid iodine 2-3 mL plus hydroxycamptothecin injection 10 mg) .The therapeutic effects of the two groups before and after treatment,the changes of immune function,adverse reactions and follow-up were compared.Results①AFP volume and intrahepatic metastasis of local chemotherapy combined TACE group were significantly lower than the systemic chemotherapy group[(56 ±4) μg/L vs (290 ±25) μg/L,(22 ±4) cm3 vs (45 ± 9) cm3 ,P<0.01]; ②CD3 +,CD4 +,CD4 +/CD8 +,CD16 +CD56 +and CD19 +levels of local chemothera-py combined TACE group after treatment were significantly higher than before treatment(P<0.05),and were significantly higher than the systemic chemotherapy group[(74 ±10)% vs (62 ±4)%,(44 ±10)%vs (31 ±7)%,( 2.7 ±0.6) vs (1.3 ±0.4),P<0.01];③the adverse reactions of the two groups had no significant difference (P>0.05);④2,3 years survival rate of the systemic chemotherapy group was signifi-cantly lower than local chemotherapy combined TACE group(44.4% vs 66.7%,26.7% vs 51.1%,P <0.05).Conclusion TACE combined local perfusion chemotherapy can effectively prevent colon cancer me-tastasis to liver, and can improve the overall survival of patients.