發(fā)布時間：2018-12-09 16:44

【摘要】：目的:雖然目前原發(fā)性肝癌的早期診斷水平有了很大的提高,但原發(fā)性肝癌起病隱匿,多數患者就診時病期已屬中、晚期,腫瘤直徑已屬于大肝癌甚至巨塊型肝癌。對于巨塊型肝癌,排除手術禁忌后,大多數情況下首選手術治療。但由于術后復發(fā)率高,預后差,因此有必要研究如何改善巨塊型肝癌患者的預后。本文通過回顧性分析,追蹤隨訪患者手術切除后肝功能、生存時間等,以對巨塊型肝癌術前輔助性經導管肝動脈化療栓塞術(transcatheter hepatic arterial chemoembolization,TACE)聯合降期手術切除與一期手術切除兩種治療方案的療效進行比較,進而評價術前輔助性肝動脈化療栓塞對巨塊型肝癌預后的影響。方法:對廈門大學附屬中山醫(yī)院肝膽外科在2010年1月至2015年3月期間收住院治療的通過病理診斷為肝細胞性肝癌的巨塊型肝癌31例進行回顧性分析,將其分為術前輔助性TACE治療聯合降期手術組和一期手術組,記錄其一般情況、治療情況及相關臨床指標,采用Kaplan-Meier法、Log-Rank檢驗評價兩種治療方式對預后的影響。結果:通過臨床觀察和隨訪,?肝臟腫瘤變化情況:術前輔助性TACE治療聯合降期手術組(n=10例)中有8例予以術前輔助性TACE治療后腫瘤體積明顯縮小者,占80%,其中有6例腫瘤大小由巨塊型肝癌降至非巨塊型肝癌(10 cm),而有2例予以術前TACE治療后腫瘤體積較TACE前增大,未出現腫瘤體積無明顯變化病例,無術前TACE治療后出現肝內、肝外轉移的病例。術前輔助性TACE治療聯合降期手術組中腫瘤壞死者8例,占80%,其中完全壞死率20%(2/10);而一期手術組腫瘤壞死率4.8%(1/21),無腫瘤完全壞死病例,兩組腫瘤壞死率有明顯統(tǒng)計學差異(P0.05)。?圍手術期情況:術前輔助性TACE治療聯合降期手術組與一期手術組術前肝功能、術后第1天、術后第3天及術后第6天肝功能無明顯差異(P0.05)。2組術后均未出現肝功能進一步惡化甚至肝功能衰竭。術前輔助性TACE治療聯合降期手術組病例與一期手術組在手術用時、術中出血量及術后三天腹腔引流管引流量無明顯統(tǒng)計學差異(P0.05)。?預后:術前輔助性TACE治療聯合降期手術組與一期手術組生存曲線、無瘤生存曲線相比較其差異有統(tǒng)計學意義(P0.05)。結論:術前輔助性TACE治療可縮小巨塊型肝癌的腫瘤,增加其手術切除的機會,并且可能有助于改善巨塊型肝癌手術后的無瘤生存率和總生存率,并不會引起顯著的肝功能損害及手術難度的增加,不會延緩手術后的恢復。
[Abstract]:Objective: although the level of early diagnosis of primary liver cancer has been greatly improved at present, the onset of primary liver cancer is hidden, most of the patients were in the middle stage of the disease, and in the late stage, the diameter of the tumor has already belonged to the large liver cancer or even the massive liver cancer. For large-scale liver cancer, surgical treatment is preferred in most cases after surgical taboos are excluded. However, due to the high recurrence rate and poor prognosis, it is necessary to study how to improve the prognosis of massive liver cancer patients. By retrospective analysis, the liver function and survival time after surgical resection were followed up in patients with giant hepatocellular carcinoma (HCC). The objective of this study was to evaluate the hepatic arterial chemoembolization (transcatheter hepatic arterial chemoembolization,) in patients with giant hepatocellular carcinoma before and after operation. To evaluate the effect of preoperative adjuvant hepatic arterial chemoembolization (TACE) on the prognosis of massive hepatocellular carcinoma (HCC). Methods: a retrospective analysis was made on 31 cases of massive hepatocellular carcinoma diagnosed pathologically as hepatocellular carcinoma in the Department of Hepatobiliary surgery, Zhongshan Hospital affiliated to Xiamen University, from January 2010 to March 2015. The patients were divided into two groups: preoperative adjuvant TACE therapy combined with descending operation group and primary operation group. The general situation, treatment status and related clinical indexes were recorded. The influence of two treatment methods on prognosis was evaluated by Kaplan-Meier method and Log-Rank test. Results: through clinical observation and follow-up,? The changes of hepatic tumor: in the preoperative adjuvant TACE therapy combined with descending operation group (n = 10), 8 cases (80%) had tumor volume significantly reduced after preoperative adjuvant TACE treatment. In 6 cases, the tumor size decreased from massive hepatocellular carcinoma to non-giant type liver cancer (10 cm), while in 2 cases after TACE treatment before operation, the tumor volume increased compared with that before TACE. There was no significant change in tumor volume in 6 cases, and no intrahepatic changes occurred after preoperative TACE treatment. Cases of extrahepatic metastasis. There were 8 cases (80%) of tumor necrosis in the preoperative adjuvant TACE therapy combined with descending operation group, in which the complete necrosis rate was 20% (2 / 10). The tumor necrosis rate was 4.8% (1 / 21) in the one-stage operation group, and there was significant difference between the two groups in tumor necrosis rate (P0.05). Perioperative period: preoperative adjuvant TACE therapy combined with reduced phase operation group and primary operation group, liver function before operation, 1 day after operation, There was no significant difference in liver function between the third day and the sixth day after operation (P0.05). There was no further deterioration of liver function or even liver failure after operation in both groups. There was no significant difference in the volume of intraoperative blood loss and the drainage of abdominal cavity drainage between the patients of the preoperative adjuvant TACE group and the first-stage operation group (P 0.05), and there was no significant difference in the volume of intraoperative bleeding and the drainage volume of the peritoneal drainage tube 3 days after operation between the two groups (P0.05). Prognosis: there was significant difference in survival curve and tumor-free survival curve between preoperative adjuvant TACE therapy combined with operation group and one-stage operation group (P0.05). Conclusion: preoperative adjuvant TACE therapy can reduce the tumor size and increase the chance of resection, and may help to improve the tumor-free survival rate and overall survival rate. It does not cause significant damage to liver function and increase the difficulty of operation, and does not delay the recovery after operation.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.7

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