作　　者： ; ; ; ;

机构地区： 佛山市第一人民医院

出　　处： 《中华肝脏外科手术学电子杂志》 2019年第6期547-551,共5页

摘　　要： 目的探讨TACE与射频消融(RFA)联合索拉非尼治疗多发性肝癌合并门静脉癌栓的疗效。方法回顾性分析2014年1月至2018年1月在佛山市第一人民医院收治的68例多发性肝癌合并门静脉癌栓患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男44例,女24例;年龄28~58岁,中位年龄44岁。根据治疗方式将患者分为索拉非尼组和TACE+RFA组,两组各34例。索拉非尼组予以TACE+RFA联合索拉非尼治疗。两组患者肝功能、AFP、VEGF水平比较采用t检验,不良反应发生率和生存率比较采用χ^2检验。结果索拉非尼组患者治疗后1个月客观缓解率和疾病控制率分别为62%(21/34)、85%(29/34),明显高于TACE+RFA组的41%(14/34)、74%(25/34)(χ^2=2.885,1.439;P<0.05)。治疗后索拉非尼组AFP和VEGF水平分别为(251±43)、(106±10)μg/L,明显低于TACE+RFA组的(421±68)、(154±13)μg/L(t=-3.023,-3.321;P<0.05)。索拉非尼组皮疹、呕吐发生率分别为24%(8/34)、29%(10/34),明显高于TACE+RFA组的6%(2/34)、9%(3/34)(χ^2=4.221,4.660;P<0.05)。索拉非尼组1年生存率为88%(30/34),明显高于TACE+RFA组的68%(23/34)(χ^2=12.645,P<0.05)。结论TACE+RFA联合索拉非尼是晚期肝癌患者有效的治疗方法,可用于多发性肝癌合并门静脉癌栓患者的临床治疗,但应注意其不良反应与相关并发症。 Objective To evaluate the clinical efficacy of TACE combined with radiofrequency ablation(RFA)and sorafenib in the treatment of multiple liver cancer complicated with portal vein tumor thrombus.Methods Clinical data of 68 patients with multiple liver cancer complicated with portal vein tumor thrombus admitted to the First People's Hospital of Foshan from January 2014 to January 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,44 patients were male and 24 female,aged from 28 to 58 years old with a median age of 44.All 68 patients were divided into the sorafenib group and TACE+RFA group according to different treatments,with 34 cases in each group.In sorafenib group,TACE+RFA combined with sorafenib was delivered.The liver function,AFP and VEGF levels were statistically compared between two groups by t test.The incidence of adverse reactions and survival rate were statistically compared by Chi-square test.Results In sorafenib group,the objective remission rate and disease control rate were 62%(21/34)and 85%(29/34),significantly higher than 41%(14/34)and 74%(25/34)in TACE+RFA group(χ2=2.885,1.439;P<0.05).After treatments,the AFP and VEGF levels in sorafenib group were(251±43)and(106±10)μg/L,significantly lower compared with(421±68)and(154±13)μg/L in TACE+RFA group(t=-3.023,-3.321;P<0.05).The incidence of rash and vomiting in sorafenib group was 24%(8/34)and 29%(10/34),significantly higher than 6%(2/34)and 9%(3/34)in TACE+RFA group(χ2=4.221,4.660;P<0.05).In sorafenib group,the 1-year survival rate was 88%(30/34),significantly higher than 68%(23/34)in TACE+RFA group(χ2=12.645,P<0.05).Conclusions TACE+RFA combined with sorafenib is an efficacious treatment for advanced liver cancer.It can be used in treating multiple liver cancer complicated with portal vein tumor thrombus.Nevertheless,extensive attention should be paid to the adverse reactions and relevant complications.

关 键 词： 癌 肝细胞 经导管动脉化疗栓塞 射频消融 索拉非尼

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