本文選題：原發(fā)性肝癌 + 肝動(dòng)脈化療栓塞�。� 參考：《山東大學(xué)》2015年碩士論文

【摘要】：原發(fā)性肝癌是消化系統(tǒng)常見的惡性腫瘤,早期發(fā)病隱匿,等到確診時(shí)往往已經(jīng)到了中晚期,手術(shù)效果欠佳�，F(xiàn)在以TACE為主的微創(chuàng)介入治療成為中晚期肝癌主要的治療手段。TACE主要是將導(dǎo)管選擇性或超選擇性插入到腫瘤供血靶動(dòng)脈后,使用化療藥物進(jìn)行局部化療并以適當(dāng)?shù)乃俣茸⑷脒m量的栓塞劑,使靶動(dòng)脈閉塞,引起腫瘤組織的缺血壞死。栓塞在TACE治療肝癌的過程中起到非常重要的作用,因此選擇合適的栓塞劑對(duì)TACE療效至關(guān)重要。目的觀察海藻酸鈉微球與明膠海綿兩種栓塞劑在TACE治療原發(fā)性肝癌中的療效。方法按選用栓塞劑的不同將40例原發(fā)性肝癌患者隨機(jī)平均分為兩組：KMG組(20例)：采用海藻酸鈉微球栓塞治療,海綿組(20例)：采用明膠海綿栓塞治療。選取標(biāo)準(zhǔn)為新發(fā)的腫瘤病人,腫瘤大小不超過l0cm,數(shù)目不超過3個(gè),肝功能為A或B級(jí),無遠(yuǎn)處轉(zhuǎn)移的患者。觀察兩組1個(gè)月后腫瘤大小的變化、甲胎蛋白水平的變化及3、6、12月生存期。注入化療藥及碘油的量跟患者的肝功與腫瘤大小有關(guān),病灶范圍大于5cm、肝功能為A級(jí),用碘油lOmg、三氧化二砷30mg,兩者混合后在C臂透視下注入。小于5cm的病灶或肝功能為B級(jí)減半或減量。KMG栓塞,即先將微球倒入注射器,加生理鹽水反復(fù)沖洗3次,再加入造影劑跟微球混合,經(jīng)導(dǎo)管勻速緩慢注射,根據(jù)注入栓塞劑的流速及有無反流情況來決定栓塞劑的用量,防止注入過快導(dǎo)致反流。栓塞后再次造影,根據(jù)需要可進(jìn)一步注入栓塞劑直至供血?jiǎng)用}完全栓塞。需要特別指出的是海藻酸鈉微球注入時(shí)一定要控制著緩慢注入,即剛有反流跡象時(shí)就立即停止注入,以防異位栓塞。海綿栓塞,需將海綿剪成顆粒狀混合造影劑,注入過程同KMG組。結(jié)果兩組患者術(shù)前資料沒有統(tǒng)計(jì)學(xué)意義(P0.05)；治療后1個(gè)月KMG組有16例腫瘤縮小(80%),對(duì)照組有10例腫瘤縮小(50%)；治療前KMG組有16例AFP高于正常,經(jīng)治療后1個(gè)月KMG組12例數(shù)值下降超過30%(75%),其中5例降到正常水平。對(duì)照組AFP有14例高于正常,治療后7例數(shù)值下降超過30%(50%),2例降到正常水平。KMG組和海綿組3、6個(gè)月的生存率分別為90%、70%和80%、65%(P值均0.05),1年的生存率分別為50%、30%(P0.05)。結(jié)論與明膠海綿相比,海藻酸鈉微球栓塞在TACE治療原發(fā)性肝癌中的遠(yuǎn)期效果更好。
[Abstract]:Primary liver cancer is a common malignant tumor of digestive system. At present, minimally invasive interventional therapy based on TACE has become the main treatment method for advanced liver cancer. TACE mainly inserts catheter selectivity or superselectivity into the target artery of tumor supply. Local chemotherapy with chemotherapeutic drugs and injection of appropriate amount of embolic agent at a suitable speed make the target artery occluded and cause the tumor tissue to be ischemic and necrotic. Embolization plays a very important role in the treatment of liver cancer by TACE, so it is very important to select the suitable embolization agent for the treatment of TACE. Objective to observe the efficacy of sodium alginate microsphere and gelatin sponge in the treatment of primary liver cancer with TACE. Methods 40 patients with primary liver cancer were randomly divided into two groups according to the choice of embolic agent: 20 cases of KMG group were treated with sodium alginate microsphere embolization and 20 cases of sponge group were treated with gelatin sponge embolization. The tumor size was less than 10 cm, the number of tumor was not more than 3, the liver function was grade A or B, and there was no distant metastasis. The changes of tumor size, alpha-fetoprotein level and the survival time of 36 months and 12 months after 1 month in both groups were observed. The amount of chemotherapeutic drugs and lipiodol was related to the liver function and tumor size. The focus was more than 5 cm, liver function was grade A, lipiodol 1 Omg, arsenic trioxide 30 mg, and then injected under C arm fluoroscopy. The focus or liver function less than 5cm was reduced by half or reduced. KMG embolization, that is, the microspheres were poured into the syringe, rinsed with normal saline for 3 times, then mixed with contrast agent and microsphere, and injected slowly through the catheter. The dosage of embolic agent is determined according to the flow rate and reflux of the injected embolizer, so as to prevent the injection of too fast to cause the regurgitation. After embolization, the embolization can be further injected until the feeding artery is completely embolized. It should be pointed out that the injection of sodium alginate microspheres must be controlled by slow injection, that is, the injection should be stopped immediately when there are signs of reflux, in order to prevent ectopic embolism. Sponge embolization, sponge cut into granular mixed contrast agent, injection process the same as KMG group. Results there was no significant difference in preoperative data between the two groups (P 0.05), 16 patients in KMG group had 80 cases of tumor shrinkage one month after treatment, 10 cases in control group had reduced tumor volume 50%, and 16 cases in KMG group had AFP higher than normal before treatment. One month after treatment, the number of 12 cases in KMG group decreased by more than 30 ~ 7575%, among which 5 cases decreased to normal level. In the control group, 14 cases of AFP were higher than normal, 7 cases decreased more than 30%, 2 cases decreased to normal level. KMG group and sponge group, the survival rate at 6 months were 90% and 80% and 0.05%, respectively. The 1 year survival rate was 50% and 30%, respectively. Conclusion compared with gelatin sponge, sodium alginate microsphere embolization is more effective in the treatment of primary liver cancer with TACE.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.7;R730.5

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