| 摘要: |
| 目的:采用随机对照研究评价可切除大肝癌术前肝动脉插管化疗（TACE）对术后肝功能恢复及患者生存率的价值。方法:采用随机对照实验的方法，将2001年7月至2003年12月符合纳入标准的108例可切除大肝癌（直径≥5 cm）患者随机分为一期手术组（OP组，n=56）和TACE+手术组（TACE+OP组，n=52）。比较两组患者术中情况，肿瘤切除率，手术前后肝功能变化，术后1、3、5年无瘤生存率及总生存率的差异。结果:术前两组患者基线情况一致。TACE+OP组插管化疗后γ-球蛋白水平明显高于OP组（P=0.046），手术切除后第7天前白蛋白水平明显低于OP组（P=0.031）。OP组平均手术时间明显短于TACE+OP组（P=0.042），肿瘤切除率明显高于TACE+OP组（P=0.017)，肿瘤转移患者明显少于TACE+OP组（2 vs 9,P=0.018）。两组患者术中肝血流阻断时间及出血量以及术后1、3、5年无瘤生存率及总生存率均无统计学差异。结论:可切除大肝癌术前TACE并不能延长术后无瘤生存期及总生存期，且可能促进肿瘤转移，损害肝功能。 |
| 关键词: 肝肿瘤 肝细胞癌 肝切除术 经导管肝动脉栓塞化疗术 生存率 |
| DOI：10.3724/SP.J.1008.2009.01379 |
| 投稿时间：2009-10-20修订日期：2009-11-26 |
| 基金项目: |
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| Effect of preoperative transcatheter arterial chemoembolization for treatment of resectable large hepatocellular carcinoma:a clinical randomized controlled trial |
| TANG Qing-he,ZHOU Jian-ping,FU Si-yuan,ZHOU Wei-ping* |
| (The Third Department of Hepatic Surgery,Eastern Hepatobiliary Hospital,Second Military Medical University,Shanghai 200438,China) |
| Abstract: |
| Objective:To evaluate the effect of preoperative transcatheter arterial chemoembolization (TACE) on liver function and survival of patients after resection of large hepatocellular carcinoma (HCC) by a randomized controlled approach.Methods: From July 2001 to December 2003, a total of 108 patients with resectable large HCC（≥ 5 cm）,who met the inclusion criteria,were prospectively randomized into surgical resection group (OP group,n=56) or preoperative TACE group (TACE+OP group,n=52).Operative outcomes,resection rate,1-,3-,and 5-year tumor-free survival rates and overall survival rate were compared between the two groups.Results: The preoperative baseline conditions were equivalent between the two groups.The γ-globulin level in TACE+OP group was significantly higher than that in the OP group（P=0.046）after chemoembolization.The prealbumin level was significantly lower than that of the OP group seven days after operation（P=0.031）.Compared with TACE+OP group,OP group had a significantly higher resection rate (100% vs 89.4%,P=0.017),a less average operative time (P=0.042),and less metastases (2 vs 9,P=0.018).There were no significant differences between the two groups in intraoperative blood loss,warm ischemic time,1-,3-,and 5-year tumor-free survival rates,or overall survival rate.Conclusion: The preoperative TACE can not improve post-operative tumor-free and overall survival rates, and it may result in tumor metastasis or hepatic function damages. |
| Key words: liver neoplasms hepatocellular carcinoma heptatic resection transcatheter arterial chemoembolization survival rate |
