肝动脉化疗栓塞术后二期手术切除对中晚期肝癌病人治疗效果.docVIP

肝动脉化疗栓塞术后二期手术切除对中晚期肝癌病人的治疗效果 　　作者：师礼鹏，张东生，于江，步向阳，陈增银 作者单位：青岛市市立医院东院肝胆外科，山东 青岛 266071 　　【摘要】 　　目的 探讨经肝动脉化疗栓塞(TACE) 结合二期手术切除治疗原发性中晚期肝癌的价值。方法用TACE治疗无手术指征的中晚期肝癌，有26例病人肿瘤缩小后获得二期手术切除肿瘤的机会，随访并分析其术后并发症，复发以及远期生存情况。结果 26例中14例病人待手术时肿瘤缩小50%以上，12例待手术时肿瘤缩小30%～50%。二期手术切除术后1、3、5年无瘤生存率为72.9%、44.2%、15.1%,中位无瘤生存期32个月。总体1、3、5年累积生存率为88.3%、59.5%、30.4%，中位生存期43个月。结论 TACE并二期手术切除对中晚期原发性肝癌的疗效和提高远期生存率具有一定的价值, 是临床值得应用的治疗方法。 　　【关键词】 肝肿瘤　化学栓塞　治疗性　外科手术 　　THERAPEUTIC EFFECT OF HEPATECTOMY COMBINED WITH HEPATIC ARTERIAL CHEMOEMBOLIZATION ON PATIENTS WITH ADVANCED LIVER CARCINOMA 　　SHI LIPENG, ZHANG DONGSHENG, YU JIANG, et al 　　(Department of Hepatobiliary Surgery, Qingdao Municipal Hospital, Qingdao 266071, China); 　　[ABSTRACT]Objective To evaluate the value of transhepatic arterial chemoembolization (TACE) combined with secondary hepatectomy for advanced primary liver carcinoma. Methods Twentysix patients with advanced primary liver carcinoma (APLC) who were considered with no indication of surgery were treated with TACE first, and then underwent secondary hepatectomy when the tumors got smaller. Postoperative complications, recurrence, and longterm survival were followed and analyzed.Results The tumor size diminished more than 50% in 14 patients, between 30%-50% in 12 after TACE. Postoperatively, the tumorfree 1, 3and 5year survival rates were 72.9%, 44.2% and 15.1%, respectively. The median tumorfree survival time was 32 months. Totally, the 1, 3and 5year cumulative survival rates were 88.3%, 59.5% and 30.4%, respectively, median cumulative survival time was 43 months. Conclusion Hepatectomy after TACE is an effective method for intermediate and late stage liver cancers to increase longterm survival, which is a therapy worth to be used clinically. 　　[KEY WORDS] tumor of liver; chemoembolization, therapeutic; surgical procedures 　　原发性肝癌目前的根治性治疗手段仍为手术切除, 但确诊时不能手术切除的肝癌病人仍占绝大多数。随着经导管肝动脉化疗栓塞(TACE)技术的普遍应用，使其中一部分原先不能切除的原发性肝癌缩小后获得二期手术切除的机会，并有可能获得根治[12]。1999