CAJ | 학술논문

目的：分析贝伐单抗动脉灌注联合化疗栓塞术（TACE）治疗原发性肝癌患者的血管造影变化，评价其治疗的有效性和安全性。方法选取2012年10月—2013年8月于新疆医科大学第一附属医院至少经过1次 TACE治疗 ART 评分≥2.5分的13例原发性肝癌患者为研究对象，给予其贝伐单抗动脉灌注联合 TACE 治疗。治疗后于2012年11月—2014年3月进行随访，患者每隔4~8周入院复查，评价治疗效果及不良反应，并观察患者血管造影表现。结果第1次贝伐单抗动脉灌注联合 TACE 治疗后，3例患者疾病进展（PD），未再次行贝伐单抗动脉灌注联合 TACE治疗；其余10例患者接受第2次贝伐单抗动脉灌注联合 TACE 治疗，动脉造影可见肿瘤血管明显减少，而剩余的血管出现正常化表现，部分未沉积碘油颗粒的病灶在延迟期未见显影；正常肝动脉血管管径变细，肿瘤组织血流量降低。在随访过程中，1例患者随访1次后因更改联系方式失访。随访的12例患者中，4例死亡，8例存活。无疾病进展生存时间为356.5 d（220~452 d），中位生存时间为410.0 d（246~585 d）。13例患者术后评价疗效完全缓解（CR）0例，部分缓解（PR）2例，疾病稳定（SD）8例和 PD 3例。未观察到其他严重药物及治疗相关性不良反应发生。结论贝伐单抗动脉灌注联合 TACE 用于治疗肝细胞癌患者，动脉造影可见肿瘤血管减少，肿瘤血管正常化，安全、有效，对TACE 治疗后 ART 评分≥2.5分的患者不失为一个有效的替代策略。
목적：분석패벌단항동맥관주연합화료전새술（TACE）치료원발성간암환자적혈관조영변화，평개기치료적유효성화안전성。방법선취2012년10월—2013년8월우신강의과대학제일부속의원지소경과1차 TACE치료 ART 평분≥2.5분적13례원발성간암환자위연구대상，급여기패벌단항동맥관주연합 TACE 치료。치료후우2012년11월—2014년3월진행수방，환자매격4~8주입원복사，평개치료효과급불량반응，병관찰환자혈관조영표현。결과제1차패벌단항동맥관주연합 TACE 치료후，3례환자질병진전（PD），미재차행패벌단항동맥관주연합 TACE치료；기여10례환자접수제2차패벌단항동맥관주연합 TACE 치료，동맥조영가견종류혈관명현감소，이잉여적혈관출현정상화표현，부분미침적전유과립적병조재연지기미견현영；정상간동맥혈관관경변세，종류조직혈류량강저。재수방과정중，1례환자수방1차후인경개련계방식실방。수방적12례환자중，4례사망，8례존활。무질병진전생존시간위356.5 d（220~452 d），중위생존시간위410.0 d（246~585 d）。13례환자술후평개료효완전완해（CR）0례，부분완해（PR）2례，질병은정（SD）8례화 PD 3례。미관찰도기타엄중약물급치료상관성불량반응발생。결론패벌단항동맥관주연합 TACE 용우치료간세포암환자，동맥조영가견종류혈관감소，종류혈관정상화，안전、유효，대TACE 치료후 ART 평분≥2.5분적환자불실위일개유효적체대책략。
Objective To analyse the angiographic appearance of patients with primary hepatocellular carcinoma who are treated with arterial infusion with Bevacizumab combined with transcatheter arterial chemoembolization( TACE),and to evaluate the efficacy and safety of the treatment. Methods 13 patients with primary hepatocellular carcinoma who underwent TACE at least 1 time in the First Affiliated Hospital of Xinjiang Medical University from October 2012 to August 2013,were selected as study subjects,ART score of each case was ≥ 2. 5 points after treatment,all cases were treated with arterial infusion with Bevacizumab combined with TACE. After combination treatment,all cases were followed up from November 2012 to March 2014,all cases received reexamination every 4 - 8 weeks,the therapeutic effects and adverse reactions were evaluated,and the angiographic appearance was observed. Results After the first treatment with arterial infusion with Bevacizumab combined with TACE,3 patients did not undergo the second combination treatment because of progression disease(PD),the other 10 patients received the second combination treatment. The angiographic appearance showed the number of tumor vascular decreased significantly,the remaining vessels appeared normal,and some lesions without iodine oil particles deposition were not visualized in the delayed phase;the diameter of normal hepatic artery decreased,and blood flow volume of tumor tissues decreased. During follow - up,1 patient lost contact with research team due to ways of contact changed. Among the remaining 12 patients,4 patients died,8 patients survived. The mean progression free survival was 356. 5 d(220 - 452 d),the median overall survival time was 410. 0 d(246 - 585 d). According to results of postoperative efficacy evaluation,nobody experienced a complete response(CR),a partial response(PR)was observed in two patients,and eight showed a stable disease( SD),the other three cases showed a PD. The drug - related and treatment - related adverse effects were not observed. Conclusion When treating hepatocellular carcinoma patients with arterial infusion with Bevacizumab combined with TACE,the decreased number of tumor vascular and tumor vascular normalization can be seen through arteriography,the combination treatment is safe and effective,and is a valid alternative strategy for the patients whose ART score are ≥ 2. 5 points after TACE treatment.