本文選題：經(jīng)導(dǎo)管肝動(dòng)脈化療栓塞術(shù) + 肝癌��； 參考：《青海大學(xué)》2013年碩士論文

【摘要】：目的：采用RECIST實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)探討經(jīng)導(dǎo)管肝動(dòng)脈化療栓塞術(shù)(Transcatheter hepatic arterial chemoembolization, TACE)治療中晚期原發(fā)性肝癌（primary hepatic carcinoma，PHC）的臨床療效。 資料與方法： 1．臨床資料：研究分析2011年3月至2013年2月期間經(jīng)TACE治療的40例中晚期原發(fā)性肝癌患者(年齡54.9±10.8歲)，其中男性37例，女性3例。40例患者入院后均經(jīng)臨床檢查、實(shí)驗(yàn)室檢查及影像學(xué)檢查和/或病理證實(shí)明確診斷,均符合2001年中國抗癌協(xié)會(huì)肝癌專業(yè)委員會(huì)制定的原發(fā)性肝癌的診斷與分期標(biāo)準(zhǔn)。 入組標(biāo)準(zhǔn)：原發(fā)性肝癌中期(23例)或晚期(17例)；肝功能為Child A級(jí)(19例)或B級(jí)(21例)；經(jīng)TACE術(shù)前評(píng)估，符合TACE介入治療的適應(yīng)證。 腫瘤情況：共56個(gè)病灶，其中小于等于2cm的病灶2個(gè)，大于2cm且小于等于5cm的病灶17個(gè)，大于5cm的病灶37個(gè)。 2．治療方法： 2.1影像設(shè)備：德國西門子公司ANGIOSTAR PLUS1000MA數(shù)字減影管造影機(jī)。 2.2治療過程：采用Seldinger穿刺插管方法,經(jīng)皮股動(dòng)脈穿刺插管成功后,常規(guī)在腹腔干動(dòng)脈和腸系膜上動(dòng)脈置管造影，以了解肝腫瘤的血液供應(yīng)，判斷有無肝動(dòng)脈變異，以及有無異常的肝動(dòng)一靜脈分流，若有分流則先封堵瘺口。導(dǎo)管前端的位置：若給肝腫瘤供血的動(dòng)脈較粗，則直接將肝管超選過去，若供血?jiǎng)用}較纖細(xì)，則使用同軸微導(dǎo)管。盡量超選擇，否則會(huì)損傷正常肝組織。栓塞后造影以確定栓塞效果。 3．療效評(píng)價(jià)和隨訪：①術(shù)后一月復(fù)查上腹部CT一次，評(píng)估碘化油沉積情況及腫瘤大小的變化。②術(shù)后一月復(fù)查甲胎蛋白一次，比較治療前后的情況。③TACE術(shù)后均觀察患者癥狀、KPS評(píng)分等情況，并根據(jù)復(fù)查結(jié)果制定下面的的治療方案。 4．統(tǒng)計(jì)學(xué)方法：數(shù)據(jù)通過SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。差異顯著性檢驗(yàn):計(jì)量資料之間行t檢驗(yàn)或秩和檢驗(yàn);檢驗(yàn)水準(zhǔn)：α=0.05。 結(jié)果： 1.患者TACE術(shù)后一周臨床癥狀的改變：第一次TACE術(shù)后，臨床癥狀改善85%（34/40）、無明顯改善10%（4/40）、加重5%（2/40）。 2.患者TACE術(shù)后一周KPS功能狀態(tài)評(píng)分情況：第一次TACE術(shù)前、后KPS功能狀態(tài)評(píng)分之間的差別具有統(tǒng)計(jì)學(xué)意義(秩和檢驗(yàn)，PO．05)。 3.患者TACE術(shù)后一月病灶內(nèi)碘化油沉積的狀況：第一次TACE術(shù)后，，病灶內(nèi)碘油沉積Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型、Ⅴ型構(gòu)成比分別為22.5%（9/40）、22.5%（9/40）、17.5%（7/40）、7.5%（3/40）、30.0%（12/40）；Ⅰ型、Ⅱ型和Ⅲ型構(gòu)成比合計(jì)為62.5%。 4.患者TACE術(shù)后一月AFP的改變：患者第一次TACE術(shù)前、后AFP值之間的差別具有統(tǒng)計(jì)學(xué)意義(秩和檢驗(yàn)，PO．05)。 5.患者TACE術(shù)后，采用RECIST實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)，計(jì)算總有效率：第一次TACE術(shù)后：CR0例,PR19例,SD9例,PD12例,總有效率為47.5%；第二次TACE術(shù)后：CR0例,PR5例,SD6例,PD4例,總有效率為33.3%；第三次TACE術(shù)后：CR0例,PR2例,SD2例,PD2例,總有效率為33.3%。 6.患者TACE術(shù)后病灶明顯縮小至5cm以內(nèi)者達(dá)7例,可以再次爭(zhēng)取外科手術(shù)切除。 7.患者無進(jìn)展生存時(shí)間：TACE術(shù)后，患者無進(jìn)展生存時(shí)間中位數(shù)為86天(20-609天)。 8.生存率：TACE術(shù)后隨訪，患者6個(gè)月及12個(gè)月的生存率分別為77.5%（31/40）、42.5%（17/40）。 結(jié)論：經(jīng)導(dǎo)管肝動(dòng)脈化療栓塞術(shù)(TACE)是中晚期原發(fā)性肝癌的有效治療手段,能有效改善患者臨床癥狀，提高生存質(zhì)量，為再次爭(zhēng)取外科手術(shù)切除創(chuàng)造條件，并延長患者生命。
[Abstract]:Objective: To evaluate the clinical efficacy of Transcatheter hepatic arterial chemoembolization (TACE) in the treatment of advanced primary liver cancer (primary hepatic carcinoma, PHC) by using the standard of RECIST solid tumor.
Information and methods:
1. clinical data: analysis of 40 patients with advanced primary liver cancer (age 54.9 + 10.8 years) treated by TACE from March 2011 to February 2013, including 37 males and 3 cases of female.40 patients after admission to hospital, laboratory examination, imaging examination and / or pathophysiology confirmed diagnosis, all in accordance with the China anticancer Association in 2001. Criteria for diagnosis and staging of primary liver cancer developed by Specialized Committee.
Criteria: primary liver cancer (23 cases) or late stage (17 cases); liver function Child a (19 cases) or class B (21 cases); the preoperative assessment of TACE accords with the indication of TACE intervention.
Tumor situation: a total of 56 lesions, of which 2 lesions less than or equal to 2cm, 17 lesions larger than 2cm and less than 5cm, 37 lesions larger than 5cm.
2. treatment methods:
2.1 imaging equipment: SIEMENS ANGIOSTAR PLUS1000MA digital subtraction angiography machine.
2.2 treatment process: using Seldinger puncture intubation method, after percutaneous femoral artery puncture intubation successfully, the normal abdominal dry artery and the superior mesenteric artery angiography were used to understand the blood supply of the liver tumor, determine the hepatic artery variation, and have abnormal hepatic arteriovenous shunt, if there is shunt, the fistula first is blocked. The front end of the catheter is first. Position: if the arterial blood supply to the liver tumor is thicker, then the liver tube is over selected. If the blood supply is thin, the coaxial micro catheter is used. The best choice is possible, otherwise the normal liver tissue will be damaged. The embolic effect is determined by the embolization.
3. evaluation and follow-up: 1 month after the operation of the upper abdomen CT, evaluate the status of the iodized oil deposition and the size of the tumor. 2. After one month reexamination of alpha fetoprotein, compare the situation before and after treatment. (3) after TACE, the symptoms of the patients, KPS score and so on were observed, and the following treatment was established according to the results of the reexamination.
4. statistical method: statistical analysis of data through SPSS17.0 software. Difference significance test: t test or rank sum test between measurement data; test level: alpha =0.05.
Result錛

本文編號(hào)：1958346