摘要
目的探讨TACE中颗粒型栓塞材料的选择。方法回顾性分析2016年6月至2018年6月,符合入组标准的原发性肝癌患者97例,按颗粒型栓塞材料的类型分为粒径100~300μm Embosphere微球组(EBM组)、150~350μm PVA颗粒组(PVA组)、150~350μm明胶海绵颗粒组(GSM组),EBM组35例,PVA组32例,GSM组30例,分别采用40%碘化油与盐酸表柔吡星注射液混悬液、3种颗粒型栓塞材料栓塞肿瘤靶血管,栓塞终点为3~5个心动周期对比剂未排空,随访术后1、3、6个月患者疾病缓解率、临床获益率,比较3组患者至疾病进展时间、总生存时间、栓塞术后综合征发生率、肝功能损害情况。结果EBM组术后1、3、6个月缓解率分别为82.86%、77.14%、71.42%,PVA组为50.00%、43.75%、37.50%,GSM组为56.67%、50.00%、46.67%;EBM组至疾病进展时间为16(95%CI 10~21)个月、PVA组为8(95%CI 6~9)个月、GSM组为9(95%CI 5~12)个月;EBM组术后腹痛、发热发生率分别为45.7%、88.6%,PVA组为75.0%、56.2%,GSM组为80.0%、56.7%;EBM组术后近期疾病缓解率高于PVA组和GSM组,至疾病进展时间长于PVA组和GSM组,腹痛发生率低于PVA组和GSM组,发热发生率高于PVA组和GSM组,EBM组与PVA组、GSM组间差异有统计学意义(P<0.0167),PVA组与GSM组间差异无统计学意义(P>0.0167);3组患者间术后临床获益率、总生存时间、恶心及呕吐发生率、肝功能损害差异无统计学意义(P>0.0167)。术后患者未出现肝功能衰竭、肝脓肿、消化道出血、胆管损伤、胆囊坏死等严重并发症,未出现手术并发症相关死亡病例。结论100~300μm Embosphere微球、150~350μm PVA颗粒、150~350μm明胶海绵颗粒栓塞原发性肝癌靶血管安全有效,100~300μm Embosphere微球栓塞术后患者近期疗效更优,更适合应用于原发性肝癌的介入栓塞治疗。
Objective To discuss the selection of optimal granular embolization material used in transcatheter arterial chemoembolizaton(TACE).Methods A total of 97 patients with primary hepatocellular carcinoma(HCC),who met the inclusion criteria and were admitted to hospital during the period from June 2016 to June 2018,were enrolled in this study.According to the type of granular embolic material,the patients were divided into 100-300μm Embosphere microspheres group(EBM group,n=35),150-350μm PVA particles group(PVA group,n=32)and 150-350μm Gelatin sponge particles group(GSM group,n=30).The suspension of 40%lipiodol and epirubicin hydrochloride together with each of the above mentioned granular embolic material was separately used for the patients of the corresponding group to occlude the target vessels.The embolization endpoint was achieved when the contrast agent could not be emptied within the time of 3-5 cardiac cycles.All the patients were regularly followed up at 1,3 and 6 months after treatment,the disease remission rate and clinical benefit rate were calculated.The time to progression(TTP),the overall survival time,the incidence of post-embolization syndrome(PES),and liver function impairment were compared between each other among the three groups.Results The disease remission rates at 1,3 and 6 months after treatment in EBM group were 82.86%,77.14%and 71.42%respectively,which were 50.00%,43.75%and 37.50%respectively in PVA group and were 56.67%,50.00%and 46.67%respectively in GSM group.The TTPs in PVA group,EBM group and GSM group were 16 months(95%CI:10-21 months),8 months(95%CI:6-9 months)and 9 months(95%CI:5-12 months)respectively.The incidences of postoperative abdominal pain and fever were45.7%and 88.6%respectively in EBM group,75.0%and 56.2%respectively in PVA group and 80.0%and56.7%respectively in GSM group.The short-term disease remission rate in EBM group was higher than that in PVA group as well as in GSM group,while TTP in EBM group was longer than that in PVA group as well as in GSM group,and the in
作者
余磊
唐璠
曹志伟
张诚琮
苏孙欢
钟越
张丽萍
YU Lei;TANG Fan;CAO Zhiwei;ZHANG Chengcong;SU Sunhuan;ZHONG Yue;ZHANG Liping(Department of Interventional Radiology,Affiliated Sanming First Hospital of Fujian Medical University,Sanming,Fujian Province 365000,China)
出处
《介入放射学杂志》
CSCD
北大核心
2020年第9期900-906,共7页
Journal of Interventional Radiology
关键词
原发性肝癌
经导管动脉化疗栓塞术
疗效
栓塞术后综合征
primary hepatocellular carcinoma
transcatheter arterial chemoembolization
curative effect
post-embolization syndrome
