本文選題：結(jié)直腸癌肝轉(zhuǎn)移 + 雷替曲塞��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:肝臟是CRC常見遠(yuǎn)處轉(zhuǎn)移的器官,外科手術(shù)切除可做到根治性治療,但是80%-90%的患者因各種原因無法接受手術(shù),介入治療因自身優(yōu)勢(shì)受到普遍關(guān)注。本研究通過觀察、分析應(yīng)用RA行肝動(dòng)脈灌注化療術(shù)TAI+化療栓塞術(shù)TACE治療結(jié)直腸癌肝轉(zhuǎn)移CRCLM的近期療效及安全性,并為進(jìn)一步研究奠定基礎(chǔ),以此推動(dòng)這種聯(lián)合方案在CRCLM治療中的研究應(yīng)用。方法:收集2013年1月至2016年8月期間,山西醫(yī)科大學(xué)附屬第一醫(yī)院介入病房收治的CRCLM患者23例,所選CRCLM患者至少接受2個(gè)周期靜脈化療,但仍為進(jìn)展期。超選擇肝轉(zhuǎn)移灶的供血?jiǎng)用},先將OXA與適量Lipiod混合后緩慢注入填充,后將MICRO留置于責(zé)任血管近端,由體外經(jīng)MICRO持續(xù)先后灌注化療藥物(OXA 100mg和RA3mg),記錄患者術(shù)后的不良反應(yīng)情況及術(shù)后4-6周復(fù)查的近期療效。結(jié)果:1.依據(jù)近期療效標(biāo)準(zhǔn):完全緩解CR 0例,部分緩解PR 8例(34.78%),疾病穩(wěn)定SD 11例(47.83%),疾病進(jìn)展PD 4例(17.39%),有效率RR 8例(34.78%),疾病控制率DCR 19例(82.61%)。2.依據(jù)轉(zhuǎn)移灶數(shù)進(jìn)行分組,其中3個(gè)轉(zhuǎn)移灶CR 0例,PR 1例(20.0%),SD 3例(60.0%),PD 1例(20.0%),RR 1例(20.0%),DCR 4例(80.0%);≥3個(gè)轉(zhuǎn)移灶CR 0例,PR 7例(38.39%),SD 8例(44.44%),PD 3例(16.67%),RR 7例(38.89%),DCR 15例(83.33%)。兩組的RR、DCR的P0.05,無顯著性差異。3.介入治療后根據(jù)藥物毒性反應(yīng)分級(jí)標(biāo)準(zhǔn):術(shù)后3天之內(nèi)大多數(shù)會(huì)出現(xiàn)不同程度的栓塞后綜合征,肝區(qū)不適(37次,59.68%)、疼痛(36次,58.06%)、惡心嘔吐(29次,46.77%)、納差(41次,66.13%)、乏力(30次,48.39%)和發(fā)熱(36次,58.06%)等,經(jīng)對(duì)癥處理后1-2周后均能很快緩解�；颊吖灿�(jì)62次治療,術(shù)后無嚴(yán)重不良反應(yīng)。結(jié)論:1.對(duì)于CRCLM全身化療仍為進(jìn)展的患者,TAI+TACE聯(lián)合方案提供了另一種有效的選擇。2.選用RA行TAI+TACE治療CRCLM療效確實(shí),無嚴(yán)重毒副反應(yīng)。3.病灶個(gè)數(shù)對(duì)TAI+TACE聯(lián)合方案治療結(jié)直腸癌肝轉(zhuǎn)移的療效無影響,疾病控制率均達(dá)到80%以上。
[Abstract]:Objective: liver is a common organ with distant metastasis in CRC. Surgical resection can achieve radical treatment, but 80% to 90% of patients can not accept surgery for various reasons, and interventional therapy is generally concerned because of its own advantages.In this study, the short-term efficacy and safety of RA with hepatic artery infusion chemotherapy, TAI chemoembolization and TACE in the treatment of colorectal cancer with hepatic metastasis CRCLM were analyzed, which laid a foundation for further study.In order to promote the combination of this regimen in the treatment of CRCLM research and application.Methods: from January 2013 to August 2016, 23 patients with CRCLM were treated in the interventional ward of the first affiliated Hospital of Shanxi Medical University. The selected CRCLM patients received at least two cycles of intravenous chemotherapy, but they were still advanced.The blood supply artery of liver metastases was superselected. OXA was mixed with moderate amount of Lipiod, then filled slowly, then MICRO was placed in the proximal end of the responsible blood vessel.OXA 100mg and RA3 mg / L were continuously infused through MICRO in vitro to record the adverse reactions of the patients and the short term efficacy of 4 to 6 weeks after operation.The result is 1: 1.According to the short-term curative effect criteria: complete CR 0 cases, partial remission PR 8 cases with 34.78T, disease stable SD 11 cases 47.83%, disease progression 4 cases 17. 39%, effective rate RR 8 cases 34. 7881%, disease control rate 19 cases (82.61%).According to the number of metastatic foci, there were 3 cases of CR 0 cases of PR and 20.0 cases of SD 3 cases of PD. One case of PD was 20. 0%, 1 case was 20. 0% of RR, 1 case was 20. 0% of DCR 4 cases, 鈮，

本文編號(hào)：1759927