CAJ | 학술논문

目的探讨肝动脉化疗栓塞(TACE)联合瘤栓内经皮无水乙醇注射(PEI)治疗原发性肝癌(HCC)伴门静脉主支瘤栓的临床疗效. 方法回顾性分析2007年1月至2010年1月收治的51例HCC伴门静脉主支瘤栓患者资料,男性38例,女性13例,年龄24 ～ 73岁,平均50.1岁.其中采用TACE联合瘤栓内PEI治疗26例(A组),只接受TACE治疗25例(B组),两组临床资料差异无统计学意义.对比观察两组患者近期内门静脉瘤栓及肿瘤变化,随访生存时间.统计学分析应用SPSS18.0软件包,计量资料采用两样本均数t检验,计数资料采用x2检验或Fisher1s精确概率法,采用Kaplan-Meier计算中位生存期,log-rank法检验组间差异,以P＜0.05为差异有统计学意义. 结果两组均未发生与治疗有关的严重并发症,51例患者随访3 ～ 24个月.A、B两组TACE治疗次数分别为(3.2士1.4)次对比(2.4±0.9)次,t=2.22,P=0.032；A组瘤栓内PEI治疗2～8次.对瘤栓有效率为19/26对比10/25,x2=5.685,P=0.019.治疗3个月及6个月时肿瘤治疗反应(CR+ PR+ SD)为20/26对比18/25,x2=0.163,P=0.705;17/20对比10/19,x2=2.58,P=0.027.生存时间:A组5～ 23 (12.85±6.02)个月,B组4～ 16(8.65土3.39)个月,t=3.051,P=0.004.结论对于HCC合并门静脉主支瘤栓患者,TACE联合瘤栓内PEI治疗优于单用TACE治疗,联合治疗可以较好地控制门静脉瘤栓,增加TACE机会并延长患者生存期.
목적 탐토간동맥화료전새(TACE)연합류전내경피무수을순주사(PEI)치료원발성간암(HCC)반문정맥주지류전적림상료효. 방법 회고성분석2007년1월지2010년1월수치적51례HCC반문정맥주지류전환자자료,남성38례,녀성13례,년령24 ～ 73세,평균50.1세.기중채용TACE연합류전내PEI치료26례(A조),지접수TACE치료25례(B조),량조림상자료차이무통계학의의.대비관찰량조환자근기내문정맥류전급종류변화,수방생존시간.통계학분석응용SPSS18.0연건포,계량자료채용량양본균수t검험,계수자료채용x2검험혹Fisher1s정학개솔법,채용Kaplan-Meier계산중위생존기,log-rank법검험조간차이,이P＜0.05위차이유통계학의의. 결과 량조균미발생여치료유관적엄중병발증,51례환자수방3 ～ 24개월.A、B량조TACE치료차수분별위(3.2사1.4)차대비(2.4±0.9)차,t=2.22,P=0.032；A조류전내PEI치료2～8차.대류전유효솔위19/26대비10/25,x2=5.685,P=0.019.치료3개월급6개월시종류치료반응(CR+ PR+ SD)위20/26대비18/25,x2=0.163,P=0.705;17/20대비10/19,x2=2.58,P=0.027.생존시간:A조5～ 23 (12.85±6.02)개월,B조4～ 16(8.65토3.39)개월,t=3.051,P=0.004.결론 대우HCC합병문정맥주지류전환자,TACE연합류전내PEI치료우우단용TACE치료,연합치료가이교호지공제문정맥류전,증가TACE궤회병연장환자생존기.
Objective To explore the therapeutic efficacy of a combined treatment modality using transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) to treat hepatocellular carcinoma (HCC) complicated with main branch intraportal vein tumor thrombosis (PVTT).Methods Clinical data was collected retrospectively for patients diagnosed with and treated for HCC plus main branch PVTT at our hospital between January 2007 and January 2010.The total study population (n =51) consisted of 38 males and 13 females,with an average of 50.1 years (range:24-73).Among these patients,26 had been treated with TACE + PEI (group A) and 25 had been treated with TACE alone (group B).Shortterm changes in PvTT (i.e.disappearance,shrinkage,and/or stability) and tumor (i.e.complete response,partial response,and/or stable disease) were assessed by using the t-test (continuous variables) or the Chi-squared or Fisher's exact tests (categorical variables).Between-group differences in survival time were assessed by the Kaplan-Meier analysis and log-rank test.Results The follow-up time ranged from 3-24 months after treatment,and no serious treatment-related complications were recorded for any of the patients (0/51).The time of TACE treatment was significantly longer for the patients receiving the combination therapy (group A:3.21.4 vs.group B:2.40.9,t =2.22,P =0.032).The patients in group A received between 2-8 PEI treatments.The TACE + PEIcombined treatment showed significantly better therapeutic efficacy for PVTT (group A:19/26 vs.group B:10/25,x2 =5.685,P =0.019).The ttmor response was significantly better in patients treated with TACE + PEI at post-treatment month 3 (group A:20/26 vs.group B:18/25,x2 =0.163,P =0.705) and month 6 (group A:17/20 vs.10/19,x2 =2.58,P =0.027).Finally,the average survival time was significantly better in patients treated with TACE + PEI (group A:12.856.02 months (range:5-23) vs.group B:8.653.39 months (range:4-16),t =3.051,P =0.004).Conclusion TACE + PEI combination therapy for main branch PVTT in HCC patients is more efficacious than TACE alone,and is associated with a longer survival time.