【摘要】：目的:探討肝細(xì)胞性肝癌(hepatocellular carcinoma,HCC)經(jīng)導(dǎo)管肝動(dòng)脈化療栓塞(transcatheter arterial chemoembolization,TACE)治療后影響TACE療效的因素和影響碘油沉積的因素。方法:回顧性分析89例HCC患者經(jīng)TACE治療前后的臨床及影像資料,對患者的年齡、性別、乙肝表面抗原(Hepatitis B surface antigen HBs Ag)血清總膽紅素(total bilirubin TBIL)、血清白蛋白(Serumalbumin ALB)、谷草轉(zhuǎn)氨酶(Aspertate Aminotransferase AST)谷丙轉(zhuǎn)氨酶(Alanine Aminotransferase ALT)、堿性磷酸酶同工酶-1(alkaline phospha-tase isosyme ALP-1)、治療前腫瘤的體積/肝臟的體積(tumor to liver volume ratio TTLVR),門靜脈癌栓(portal vein tumor thrombus PVTT)、腹水(±)、AFP及治療次數(shù)、使用的化療藥物、最后一次治療后的最近復(fù)查時(shí)間、碘油的沉積形態(tài)等資料進(jìn)行收集,并用CT體積測量工具測算治療前腫瘤的體積/肝臟的體積(tumor to liver volume ratio TTLVR)、碘油沉積的體積/肝臟的體積(lipiodol deposition rate LDR)、治療前后腫瘤體積的變化(tumor shrinkage ratio TSR),對上述資料分別采用秩和檢驗(yàn)和spearman單因素分析影響TACE的因素和影響碘油沉積的因素,對有統(tǒng)計(jì)學(xué)意義的采用cox多元線性回歸分析影響TACE療效的獨(dú)立相關(guān)因素。并將LDR分組比較,兩組間的差異用LSD法分析。結(jié)果:1、治療前PVTT(P0.001,Z/?2=-4.680)、腹水(P=0.045,rs=-1.225)、AFP(P=0.039,rs=-0.219)、ALP-1(P=0.04,rs=-0.306),TTLVR(P=0.042,rs=-0.216)為影響TSR的負(fù)相關(guān)因素,碘油的沉積形態(tài)(P=0.005,rs=1.370)、LDR(P0.001,rs=0.728)為正相關(guān)因素,其中PVTT(P=0.027)、ALP-1(P=0.005)、治療前TTLVR(P=0.017)、LDR(P0.001)為獨(dú)立影響因素,以LDR影響因素為最重要。2、年齡(P=0.016,rs=-0.254)、治療前PVTT(P0.001,Z/?2=-4.289)、TTLVR(P0.001,rs=-0.385)是影響碘油沉積的負(fù)相關(guān)因素。結(jié)論:1、影響肝癌TACE療效獨(dú)立危險(xiǎn)因素有:治療前有無門靜脈癌栓、堿性磷酸酶同工酶-1、腫瘤的體積大小及治療后碘油的沉積量,其中以碘油的沉積量為最主要危險(xiǎn)因素,不同的碘油沉積量導(dǎo)致腫瘤體積的變化有明顯不同。2、影響碘油沉積的危險(xiǎn)因素有:年齡、治療前腫瘤的大小、有無門靜脈癌栓。3、CT平掃加增強(qiáng)是肝細(xì)胞性肝癌經(jīng)TACE治療后評價(jià)其療效較常用的無創(chuàng)隨訪方法,加上其對治療前后腫瘤的體積、腫瘤的體積變化(TSR)、碘油沉積率(LDR)的測定及結(jié)合相關(guān)實(shí)驗(yàn)室指標(biāo)有助于臨床對HCC經(jīng)TACE治療后的療效判定。
[Abstract]:Objective: to investigate the factors affecting the effect of TACE and lipiodol deposition after transcatheter hepatic artery chemoembolization (transcatheter arterial chemoembolization,TACE) for hepatocellular carcinoma (hepatocellular carcinoma,HCC). Methods: the clinical and imaging data of 89 patients with HCC before and after TACE treatment were retrospectively analyzed. The age, sex, serum total bilirubin (total bilirubin TBIL), albumin (Serumalbumin ALB), of (Hepatitis B surface antigen HBs Ag) patients were analyzed retrospectively. Glutamic oxaloacetic transaminase (Aspertate Aminotransferase AST) alanine aminotransferase (Alanine Aminotransferase ALT), alkaline phosphatase isozyme 1 (alkaline phospha-tase isosyme ALP-1), volume of tumor / volume of liver (tumor to liver volume ratio TTLVR), before treatment The data of (portal vein tumor thrombus PVTT), ascites (鹵), AFP), the times of treatment, the chemotherapeutic drugs used, the latest reexamination time after the last treatment, and the deposition of lipiodol were collected. Measurement of tumor volume / liver volume before and after treatment with CT volume measurement tool (tumor to liver volume ratio TTLVR), lipiodol deposition volume / liver volume (lipiodol deposition rate LDR), changes before and after treatment (tumor shrinkage ratio TSR), The factors affecting TACE and lipiodol deposition were analyzed by rank sum test (RSR) and spearman single factor analysis, and the independent correlation factors of TACE efficacy were analyzed statistically by cox multivariate linear regression analysis. The difference between the two groups was analyzed by LSD method. Results: 1. Before treatment, PVTT (P0.001), ascites (P0. 045), AFP () -1.225), AFP (, ALP-1 (P0. 04 ~ 0. 046), TTLVR (), ascitic fluid (P0. 045), AFP (), ALP-1 (P0. 04), AFP ()-0. 306), TTLVR (- 0. 042, respectively. Rs=-0.216) was a negative correlation factor of TSR, and the depositional morphology of lipiodol oil (P0. 005), LDR () was a positive correlation factor, in which PVTT (P0. 027), ALP-1 (P0. 005), TTLVR (P0. 017), LDR (P0. 001) was the independent influencing factor before treatment. LDR was the most important factor. 2, age (P0. 016), PVTT before treatment (P0. 001) -4. 289), TTLVR (P0. 001), before treatment (P0. 001% -4. 289), TTLVR (P0. 001). Rs=-0.385) is a negative correlation factor affecting lipiodol deposition. Conclusion: 1. The independent risk factors influencing the curative effect of TACE were: portal vein tumor thrombus, alkaline phosphatase isozyme 1, tumor volume and lipiodol after treatment. Among them, the amount of lipiodol deposition was the most important risk factor, and different amount of lipiodol deposition resulted in the change of tumor volume. 2. The risk factors affecting lipiodol deposition were: age, tumor size before treatment. 3T plain scan plus enhancement is a common noninvasive follow-up method for evaluating the efficacy of TACE in evaluating the curative effect of hepatocellular carcinoma after treatment, plus the volume of tumor before and after treatment, and the change of tumor volume, (TSR),. The determination of lipiodol deposition rate (LDR) and related laboratory indexes are helpful to evaluate the clinical efficacy of HCC treated with TACE.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.7

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 何蘭芳;劉燕娜;;超聲造影在肝癌介入診療中的應(yīng)用現(xiàn)狀及研究進(jìn)展[J];中國全科醫(yī)學(xué);2013年26期

，

本文編號：2352268