CAJ | 학술논문

目的：研究FOLFOX4方案经肝动脉、肠系膜上动脉双途径治疗中晚期原发性肝癌（PHC）的临床疗效及不良反应。方法2010年11月-2013年3月以经肝动脉结合肠系膜上动脉双途径（5-Fu 400 mg/m2肝动脉灌注化疗，奥沙利铂85 mg/m2经肝动脉灌注化疗联合栓塞；亚叶酸钙200 mg/m2静脉推注d1，d2；5-Fu 600 mg/m2经肠系膜上动脉保留导管维持灌注22 h，d1，d2）即“FOLFOX4”方案治疗中晚期原发性肝癌患者21例；选取同期的单纯肝动脉栓塞治疗PHC患者21例作为对照组。均4~6周重复第2次治疗，2次治疗后评价疗效及不良反应。结果至随访时研究组和对照组的有效率分别为61．9%和28．6%，中位生存时间为14．7个月和9．4个月，差异有统计学意义（P=0．030和P=0．037）。研究组消化道反应及肝功能损伤等不良反应明显低于对照组。结论 FOLFOX4方案经肝动脉、肠系膜上动脉双途径治疗PHC临床疗效显著，不良反应轻微。
목적：연구FOLFOX4방안경간동맥、장계막상동맥쌍도경치료중만기원발성간암（PHC）적림상료효급불량반응。방법2010년11월-2013년3월이경간동맥결합장계막상동맥쌍도경（5-Fu 400 mg/m2간동맥관주화료，오사리박85 mg/m2경간동맥관주화료연합전새；아협산개200 mg/m2정맥추주d1，d2；5-Fu 600 mg/m2경장계막상동맥보류도관유지관주22 h，d1，d2）즉“FOLFOX4”방안치료중만기원발성간암환자21례；선취동기적단순간동맥전새치료PHC환자21례작위대조조。균4~6주중복제2차치료，2차치료후평개료효급불량반응。결과지수방시연구조화대조조적유효솔분별위61．9%화28．6%，중위생존시간위14．7개월화9．4개월，차이유통계학의의（P=0．030화P=0．037）。연구조소화도반응급간공능손상등불량반응명현저우대조조。결론 FOLFOX4방안경간동맥、장계막상동맥쌍도경치료PHC림상료효현저，불량반응경미。
Objective To investigate the clinical efficacy, the toxicity and side reactions of interventional chemoembolization with FOLFOX4 regimen through both hepatic artery and superior mesenteric artery, i.e. dual access technique, in treating primary hepatocellular carcinoma. Methods Between November 2010 and March 2013 at authors’ hospital, a total of 21 patients with advanced primary hepatocellular carcinoma (the study group) were treated with FOLFOX4 regimen by using dual access interventional technique. FOLFOX4 regimen included hepatic arterial infusion of 5-fluorouracil 400 mg/m2, hepatic arterial chemoembolization with iodipin and oxaliplatin 85 mg/m 2, intravenous administration of calcium folinate 200 mg/m2 IV on the first and second day, trans-superior mesenteric artery continuous infusion (lasting for 22 hours) of 5 -Fuorouracil 600 mg/m2 on the first and second day. During the same period other 21 patients with primary hepatocellular carcinoma were selected (used as the control group) to receive conventional hepatic arterial chemoembolization. In both groups, the treatment was repeated after 4-6 weeks. The therapeutic effect and the toxicity and side reactions were evaluated after the second treatment. Results The effective rate for the study group and the control group was 61.9% and 28.6% respectively, and the median survival time for the study group and the control group was 14.7 months and 9.4 months respectively. The differences in the effective rate and the median survival time between the two groups were statistically significant (P = 0.030 and P = 0.034). The occurrence of toxicity and side reactions, such as digestive tract reactions and the damage of liver function, in the study group were strikingly lower than those in the control group. Conclusion Through dual approach of hepatic artery and superior mesenteric artery catheterization, interventional chemoembolization with FOLFOX4 regimen is outstandingly effective for primary hepatocellular carcinoma, meanwhile, the side effects are very slight.