CAJ | 학술논문

目的：探讨原发性肝癌切除术后行预防性经肝动脉化疗栓塞术（TACE）或化疗灌注术（TAI）的疗效比较。方法回顾性分析2011年6月-2012年6月行原发性肝癌切除术并在术后1~3个月行预防性介入治疗的79例患者，研究终点为2013年6月。病例分为TACE（n=41）和TAI（n=38）2组。2组患者术前年龄、性别、肝功能Child-Pugh评分、术前肿瘤直径及AFP水平差异均无统计学意义。介入术中将导管超选进入肝固有动脉，造影证实无新生肿瘤血管和肿瘤病灶后经导管注入药物，TACE组采用碘油化疗药物乳剂，TAI 组则采用单纯化疗药物灌注。采用卡方检验比较2组的1年复发率， Kaplan-Meier 估计法比较无瘤生存期，t检验比较平均住院日差别。结果79例患者中共有11例患者确认为切除术后复发，总体1年复发率为13．9%，其中TACE组1年复发率为12．2%（5/41），TAI组为15．8%（6/38），差异无统计学意义（χ2=0．213，P=0．645）。 TACE组平均无瘤生存期为（21．6±1．5）个月，TAI组为（17．4±3．0）个月，TACE组明显优于TAI组（P =0．038）。 TACE组平均住院日为（6．3±1．8）d，TAI组为（5．9±2．1）d，两组差异无统计学意义（P=0．522）。结论原发性肝癌切除术后行预防性TACE或TAI的1年复发率无差别，但采用TACE可望提高患者术后的无瘤生存期。
목적：탐토원발성간암절제술후행예방성경간동맥화료전새술（TACE）혹화료관주술（TAI）적료효비교。방법회고성분석2011년6월-2012년6월행원발성간암절제술병재술후1~3개월행예방성개입치료적79례환자，연구종점위2013년6월。병례분위TACE（n=41）화TAI（n=38）2조。2조환자술전년령、성별、간공능Child-Pugh평분、술전종류직경급AFP수평차이균무통계학의의。개입술중장도관초선진입간고유동맥，조영증실무신생종류혈관화종류병조후경도관주입약물，TACE조채용전유화료약물유제，TAI 조칙채용단순화료약물관주。채용잡방검험비교2조적1년복발솔， Kaplan-Meier 고계법비교무류생존기，t검험비교평균주원일차별。결과79례환자중공유11례환자학인위절제술후복발，총체1년복발솔위13．9%，기중TACE조1년복발솔위12．2%（5/41），TAI조위15．8%（6/38），차이무통계학의의（χ2=0．213，P=0．645）。 TACE조평균무류생존기위（21．6±1．5）개월，TAI조위（17．4±3．0）개월，TACE조명현우우TAI조（P =0．038）。 TACE조평균주원일위（6．3±1．8）d，TAI조위（5．9±2．1）d，량조차이무통계학의의（P=0．522）。결론원발성간암절제술후행예방성TACE혹TAI적1년복발솔무차별，단채용TACE가망제고환자술후적무류생존기。
Objective To compare the therapeutic efficacy of preventive transcatheter arterial chemoembolization (TACE) with that of preventive transhepatic arterial infusion (TAI) for patients with primary hepatocellular carcinoma (HCC) after hepatectomy. Methods During the period from June 2011 to June 2012 at authors’ hospital, preventive transhepatic interventional therapy was employed in 79 HCC patients within three months after hepatectomy. The followed-up endpoint was in June 2013. The clinical data were retrospectively analyzed. The patients were divided into TACE group (n=41) and TAI group (n=38). No significant differences in age, sex, preoperative liver function, Child-Pugh scores, tumor size and AFP level existed between the two groups. During interventional procedure , catheterization of proper hepatic artery was performed first, which was followed by angiography in order to clarify that there were no newly-developed tumor vessels or tumor lesions in the residual liver, then the chemotherapeutic agents were infused through the catheter. The emulsion of iodized oil with chemotherapeutic agent was used in the patients of TACE group, while only chemotherapeutic agent was adopted in the patients of TAI group. By using Chi-square test the one-year recurrence rate was determined. Kaplan-Meier estimation method was used to calculate the disease-free survival time, and t test was adopted to estimate the mean hospitalization days. The results were compared between the two groups. Results Of the 79 patients, postoperative recurrence was confirmed in 11, and the overall one-year recurrence rate was 13.9%. The one-year recurrence rate of TACE group and TAI group was 12.20% and 15.79% respectively , and no significant difference in one- year recurrence rate existed between TACE group and TAI group (χ2= 0.213, P = 0.645). The average disease-free survival time of TACE group and TAI group was (21.60 ± 1.52) months and (17.38 ± 3.01) months respectively, the difference between the two groups was of statistical significance (P = 0.038). The mean hospitalization days of TACE group and TAI group were (6.30 ± 1.84) days and (5.89 ± 2.08) days respectively, and the difference between the two groups was not statistically significant (P = 0.522). Conclusion No significant difference in one-year recurrence rate exists between the patients receiving preventive TACE and the patients receiving preventive TAI after hepatectomy for HCC. Nevertheless , preventive TACE can probably improve the disease-free survival time after hepatectomy.