本文選題：原發(fā)性肝癌 + 放射治療��； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的：探討射波刀(Cyber-knife)治療肝癌對(duì)患者肝功能變化的影響,并分析射波刀后肝損傷的轉(zhuǎn)歸情況。方法： 回顧性分析2009年8月～2012年12月104例肝功能Child-Pugh分級(jí)為A-B級(jí)的肝癌患者從射波刀治療前到治療后5個(gè)月內(nèi)肝功能生化指標(biāo)、凝血功能指標(biāo)以及肝功能Child-Pugh分級(jí)的變化,觀察治療后出現(xiàn)肝損傷的情況以及轉(zhuǎn)歸,用配對(duì)t檢驗(yàn)對(duì)肝功能變化進(jìn)行分析,生存率計(jì)算采用Kapan-Meier法。結(jié)果： 治療后2個(gè)月復(fù)查CT,近期有效率(CR+PR)為80.8%。中位生存期為19個(gè)月。射波刀治療后的1-2月(3-10周)患者天冬氨酸轉(zhuǎn)氨酶升高,血清白蛋白下降,肝功能Child-Pugh積分增高,與治療前比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05),而在治療后3個(gè)月左右(11-22周)上述指標(biāo)有所改善。觀察期間,出現(xiàn)Child-Pugh積分升高的有41例(39.4%),17例(16.3%)Child-Pugh分級(jí)進(jìn)展,出現(xiàn)肝臟毒性反應(yīng)(2-3級(jí))的24例(23.1%),無(wú)4級(jí)肝臟毒性反應(yīng)。結(jié)論：射波刀治療肝癌可引起肝損傷,以治療后1～2個(gè)月肝損傷最明顯,但總體損傷均較輕微且治療后3個(gè)月左右可以逐漸恢復(fù)。對(duì)于肝功能Child-Pugh A-B級(jí)的肝癌患者行射波刀治療其肝功能可以承受。目的:探討原發(fā)性巧癌射波刀治療后肝損傷發(fā)生的影響因素,指導(dǎo)巧癌的射波刀治療,避免和減少肝損害的發(fā)生。方法:2009年8月~2012年12月肝功能Child-Pugh A~B級(jí)的行射波刀治療的肝癌患者104例,放療劑量28~55Gy/2~6f,分割劑量8~16Gy/f。觀察射波刀治療后5個(gè)月內(nèi)出現(xiàn)肝損傷的情況,運(yùn)用卡方檢驗(yàn)(chi-square test)或t檢驗(yàn)(t-test)對(duì)一般臨床因素及劑量學(xué)參數(shù)與治療后肝損傷的發(fā)生做統(tǒng)計(jì)分析。一般臨床因素包括;性別、年齡、ECOG評(píng)分、TNM分期、口靜脈癌栓、邸V感染情況、治療前謝ild-Pugh分級(jí)、GTV、放療劑量及分割劑量,劑量學(xué)參數(shù)包括;NVL、V_5、V_10、V_15、V_20、V_25及V_30。采用logistic回歸分析對(duì)有意義的因素進(jìn)行多因素分析,篩選出有統(tǒng)計(jì)學(xué)意義的獨(dú)立影響因素。結(jié)果:射波刀治療后5個(gè)月內(nèi)出現(xiàn)CMd-Pu班分級(jí)進(jìn)展的有17例,出現(xiàn)肝臟毒性反應(yīng)(2~3級(jí))的24例,未見4級(jí)肝臟毒性反應(yīng)。各臨床因素及劑量學(xué)參數(shù)與射波刀后Child-Pugh分級(jí)進(jìn)展無(wú)關(guān),而GTV、V_5、V_10、V_15、V_20、V_25及V_30與治療后肝臟毒性(2~3級(jí))的發(fā)生有關(guān),多因素分析結(jié)果顯示,僅V_25為其獨(dú)立影響因素(P0.05)。V_25預(yù)測(cè)肝臟放射耐受劑量R0C曲線下面積為0.775(%%CI:0.672~0.878),根據(jù)Youden指數(shù)最大的切點(diǎn),確定最佳界值為31.5%。結(jié)論:V25是肝癌患者射波刀放療后出現(xiàn)肝臟毒性反應(yīng)(2~3級(jí))的主要影響因素,可W作為一種有效的劑量學(xué)參數(shù)來(lái)評(píng)估射波刀治療后肝損傷的風(fēng)險(xiǎn)。
[Abstract]:Objective: to investigate the effect of Cyber-knife-treated liver function on liver function in patients with liver cancer, and to analyze the outcome of liver injury after wave knife. Methods: the changes of liver function biochemical index, coagulation function index and Child-Pugh grade of liver function in 104 patients with liver cancer with Child-Pugh grade A-B grade from August 2009 to December 2012 were analyzed retrospectively. The changes of liver function were analyzed by paired t test. The survival rate was calculated by Kapan-Meier method. Results: 2 months after treatment, the effective rate of CT was 80.8%. The median survival time was 19 months. The aspartate aminotransferase increased, the serum albumin decreased and the Child-Pugh score of liver function increased. There were significant differences between before treatment and before treatment (P 0.05), and the above indexes were improved at about 3 months after treatment for 11 to 22 weeks. During the observation period, there were 41 cases with elevated Child-Pugh score and 17 cases with Child-Pugh grade progression in 17 cases with Child-Pugh grade, and 24 cases with hepatic toxicity reaction of 2-3 grade). No grade 4 hepatic toxicity reaction was found. Conclusion: the liver injury can be induced by wave knife therapy, especially after 1 ~ 2 months of treatment, but the total injury is mild and can gradually recover 3 months after treatment. The liver function of patients with liver function Child-Pugh A-B liver cancer treated with wave knife is acceptable. Objective: to investigate the influencing factors of liver injury after radiofrequency knife therapy for primary carcinoma of carcinoma, to guide the treatment of carcinoma with wave knife, and to avoid and reduce the occurrence of liver damage. Methods: from August 2009 to December 2012, 104 patients with liver cancer with Child-Pugh Agna B grade were treated with radiosurgery at a dose of 2855 Gy / 2 and 816 Gy / f, respectively. To observe the occurrence of liver injury within 5 months after treatment with wave knife, chi-square test or t test were used to analyze the general clinical factors and dose parameters and the occurrence of liver injury after treatment. General clinical factors included gender, age, ECOG score, TNM stage, oral vein tumor embolus, V infection, GTV before treatment, radiotherapy dose and fractionation dose, dosimetric parameters including NVLV V 10 V 10 V 15 V 20 V 20 V 5 and V 30. The significant factors were analyzed by logistic regression analysis, and the independent influential factors were screened out. Results: there were 17 cases with CMd-Pu grade progression and 24 cases with hepatic toxic reaction grade 2 / 3 within 5 months after radiosurgery. No grade 4 hepatic toxic reaction was found. The clinical factors and dosimetry parameters were not related to the Child-Pugh classification after the wave knife, but the GTVV _ 5 / V _ (10) / V _ (15) / V _ (20) / V _ (25) and V _ (30) were related to the occurrence of liver toxicity after treatment. Only V _ (25) is its independent influencing factor (P _ (0.05) n 路V _ s _ 25) for predicting the area under the R0C curve of liver radiation tolerance dose is 0.775g ~ (-1) CI: 0.672 ~ (0.878). According to the maximum tangent point of Youden index, the best threshold is determined to be 31.5 ~ (th). Conclusion V25 is the main influencing factor of hepatic toxicity after radiosurgery in patients with liver cancer. W can be used as an effective dosimetric parameter to evaluate the risk of liver injury after radiosurgery.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 屈玲,府偉靈;乙型肝炎后肝硬化患者凝血功能變化與肝功能分級(jí)關(guān)系的觀察[J];重慶醫(yī)學(xué);2004年11期

2 張江靈;陳少誼;陳云萍;鄭維斌;賴燦輝;;伽瑪?shù)吨委熢l(fā)性肝癌對(duì)肝功能的影響研究[J];四川醫(yī)學(xué);2011年08期

3 孟志強(qiáng);劉魯明;馬鑫;林鈞華;陳震;陳顥;周振華;王琨;于爾辛;;394例原發(fā)性肝癌的預(yù)后因素與療效分析[J];中國(guó)癌癥雜志;2007年08期

4 童穎,楊甲梅;原發(fā)性肝癌門靜脈癌栓的形成及治療[J];中國(guó)實(shí)用外科雜志;2003年06期

5 吳孟超;原發(fā)性肝癌外科綜合治療的現(xiàn)狀和展望[J];中華外科雜志;2004年01期

6 陳櫻;朱俊;張火俊;張曉青;居小萍;盧明智;劉永明;曹洋森;于春山;王曉艷;;射波刀聯(lián)合TACE治療原發(fā)性肝癌108例[J];世界華人消化雜志;2014年14期

，

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