中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2015年
10期
763-768
,共6页
刘秋松%梅雀林%李彦豪%何晓峰%陈勇%曾庆乐%赵剑波%王江云%庞桦进
劉鞦鬆%梅雀林%李彥豪%何曉峰%陳勇%曾慶樂%趙劍波%王江雲%龐樺進
류추송%매작림%리언호%하효봉%진용%증경악%조검파%왕강운%방화진
癌,肝细胞%化疗栓塞,治疗性%疗效分析
癌,肝細胞%化療栓塞,治療性%療效分析
암,간세포%화료전새,치료성%료효분석
Carcinoma,hepatocellular%Chemoembolization,therapeutic%Treatment outcome
目的 探讨采用聚乙烯醇(PVA)联合化疗药物(或碘油化疗乳剂)对肝细胞癌合并肝动静脉分流(HAVS)患者行末梢性化疗栓塞的疗效与安全性.方法 回顾性分析采用PVA微粒联合化疗药物(或碘油化疗乳剂)行末梢性化疗栓塞治疗的97例HCC合并HAVS患者资料,根据经动脉注入对比剂到门静脉或肝静脉显影时间将HAVS分为快速型(36例)、中速型(40例)和慢速型(21例).行末梢性化疗栓塞治疗,慢速型、中速型和快速型患者分别选择300~500、501~710及711~1 000μm PVA.慢速型及中速型分流患者先用碘油化疗乳剂栓塞,再用适量PVA微粒栓塞;快速型分流患者采用单纯化疗药物溶于对比剂后与PVA微粒一同注入.采用Kaplan-Meier法计算患者生存率,并采用Log-Rank检验比较不同分流速度类型患者的生存期差异.观察术后并发症.结果 97例患者中位生存期为281 d,6、12、18个月生存率分别为67.0%、37.2%、14.2%.疾病控制率为35.2%(19/54).疾病控制组中位生存期521 d(223~818 d),进展组中位生存期281 d(125~436 d),疾病控制组和进展组的生存期差异有统计学意义(χ2=4.853,P=0.028).快速型、中速型和慢速型患者的中位生存期分别为211、230、378 d,不同分流速度类型患者的生存期差异无统计学意义(χ2=3.20,P=0.20).不同分流速度类型的分流栓塞程度差异有统计学意义(χ2=22.14,P<0.01).190次栓塞治疗后出现Child-Pugh C级11例次,急性肝功能衰竭1例次,食管胃底静脉曲张破裂出血3例次.术后30 d患者病死率为4.1%(4/97),其中3例死于食管胃底静脉曲张破裂出血.结论 采用PVA联合化疗药物(或碘油化疗乳剂)对肝细胞癌合并肝动静脉分流患者行末梢性化疗栓塞安全、有效.
目的 探討採用聚乙烯醇(PVA)聯閤化療藥物(或碘油化療乳劑)對肝細胞癌閤併肝動靜脈分流(HAVS)患者行末梢性化療栓塞的療效與安全性.方法 迴顧性分析採用PVA微粒聯閤化療藥物(或碘油化療乳劑)行末梢性化療栓塞治療的97例HCC閤併HAVS患者資料,根據經動脈註入對比劑到門靜脈或肝靜脈顯影時間將HAVS分為快速型(36例)、中速型(40例)和慢速型(21例).行末梢性化療栓塞治療,慢速型、中速型和快速型患者分彆選擇300~500、501~710及711~1 000μm PVA.慢速型及中速型分流患者先用碘油化療乳劑栓塞,再用適量PVA微粒栓塞;快速型分流患者採用單純化療藥物溶于對比劑後與PVA微粒一同註入.採用Kaplan-Meier法計算患者生存率,併採用Log-Rank檢驗比較不同分流速度類型患者的生存期差異.觀察術後併髮癥.結果 97例患者中位生存期為281 d,6、12、18箇月生存率分彆為67.0%、37.2%、14.2%.疾病控製率為35.2%(19/54).疾病控製組中位生存期521 d(223~818 d),進展組中位生存期281 d(125~436 d),疾病控製組和進展組的生存期差異有統計學意義(χ2=4.853,P=0.028).快速型、中速型和慢速型患者的中位生存期分彆為211、230、378 d,不同分流速度類型患者的生存期差異無統計學意義(χ2=3.20,P=0.20).不同分流速度類型的分流栓塞程度差異有統計學意義(χ2=22.14,P<0.01).190次栓塞治療後齣現Child-Pugh C級11例次,急性肝功能衰竭1例次,食管胃底靜脈麯張破裂齣血3例次.術後30 d患者病死率為4.1%(4/97),其中3例死于食管胃底靜脈麯張破裂齣血.結論 採用PVA聯閤化療藥物(或碘油化療乳劑)對肝細胞癌閤併肝動靜脈分流患者行末梢性化療栓塞安全、有效.
목적 탐토채용취을희순(PVA)연합화료약물(혹전유화료유제)대간세포암합병간동정맥분류(HAVS)환자행말소성화료전새적료효여안전성.방법 회고성분석채용PVA미립연합화료약물(혹전유화료유제)행말소성화료전새치료적97례HCC합병HAVS환자자료,근거경동맥주입대비제도문정맥혹간정맥현영시간장HAVS분위쾌속형(36례)、중속형(40례)화만속형(21례).행말소성화료전새치료,만속형、중속형화쾌속형환자분별선택300~500、501~710급711~1 000μm PVA.만속형급중속형분류환자선용전유화료유제전새,재용괄량PVA미립전새;쾌속형분류환자채용단순화료약물용우대비제후여PVA미립일동주입.채용Kaplan-Meier법계산환자생존솔,병채용Log-Rank검험비교불동분류속도류형환자적생존기차이.관찰술후병발증.결과 97례환자중위생존기위281 d,6、12、18개월생존솔분별위67.0%、37.2%、14.2%.질병공제솔위35.2%(19/54).질병공제조중위생존기521 d(223~818 d),진전조중위생존기281 d(125~436 d),질병공제조화진전조적생존기차이유통계학의의(χ2=4.853,P=0.028).쾌속형、중속형화만속형환자적중위생존기분별위211、230、378 d,불동분류속도류형환자적생존기차이무통계학의의(χ2=3.20,P=0.20).불동분류속도류형적분류전새정도차이유통계학의의(χ2=22.14,P<0.01).190차전새치료후출현Child-Pugh C급11례차,급성간공능쇠갈1례차,식관위저정맥곡장파렬출혈3례차.술후30 d환자병사솔위4.1%(4/97),기중3례사우식관위저정맥곡장파렬출혈.결론 채용PVA연합화료약물(혹전유화료유제)대간세포암합병간동정맥분류환자행말소성화료전새안전、유효.
Objective To evaluate the efficacy and safety of terminal chemoembolization in hepatocellular carcinoma (HCC) with hepatic arteriovenous shunts (HAVS) by polyvinyl alcohol (PVA) plus chemotherapeutic agents or chemotherapeutic agents lipiodol emulsion (CALE). Methods The medical records of 97 patients with HCC and HAVS were retrospectively analyzed. HAVS was classified into 3 types according to the timing of visualization of the arterial to venous (A-V) on arteriogram images: slow-flow HAVS (n=36), intermediate-flow HAVS (n=40) and high-flow HAVS (n=21). The size of the PVA used was determined by the following scheme: slow-flow HAVS: 300 to 500 μm; intermediate-flow HAVS: 501 to 710 μm; high-flow HAVS: 711 to 1000 μm PVA. The HCCs with slow-flow and intermediate-flow HAVS were embolized by CALE and PVA, while the High-flow HAVS were treated by PVA with chemotherapeutic agents. Survival curves were calculated by Kaplan-Meier method and compared by Log-Rank test. Postoperative complications were analyzed. Results The median overall survival (OS) was 281 days, and the 6-month, 12-month and 18-month survival rate of 97 patients with HCC and HAVS were 67.0%, 37.2%and 14.2%, respectively. The disease control rate (DCR) was 35.2%(19/54). In rate of overall survival, there was a statistically significant difference between disease control group[median OS was 521 days(223 to 818 days)] and disease progression group[median OS was 281 days(125 to 436 days)] (χ2=4.853,P=0.028). The median OS of patients with the high-flow type, intermediate-flow type and slow-flow type were 211, 230 and 378 days, respectively. There was no statistically significant difference among different HAVS types (χ2=3.20,P=0.20).The extents of embolization showed statistically significant difference (χ2=22.14,P<0.01) among different HAVS types. The Child-Pugh class C was found in 11 cases, acute liver failure occurred in 1 case, and esophageal varices bleeding happened in 3 cases. The mortality of 30-d was 4.1% (4/97), and 3 patients died of esophageal gastric varices bleeding. Conclusion It is safe and effective to treat HCC with HAVS by the terminal chemoembolization therapy with PVA plus chemotherapeutic agents (or CALE).