难以根治性切除大肝癌经TACE后二期切除的疗效分析.DOCVIP

临床医学论文-难以根治性切除大肝癌经TACE后二期切除的疗效分析 ???????????????????? 作者：俞武生， 郭荣平， 石明， 钟 崇， 韦玮， 张亚奇， 李锦清? 【摘要】? 【目的】 探讨难以根治性切除的大肝癌经TACE治疗后手术切除的意义及疗效。【方法】 分析143例难以根治性切除的大肝癌临床病理资料，其中68例经TACE治疗后二期切除（A组），75例未行术前TACE单纯切除（B组）。观察TACE前后肿瘤变化情况，比较两组患者的术后情况、癌残留率，以及两组病人的术后生存率及无瘤生存率。【结果】 ①A组经TACE后肿瘤有不同程度的缩小，且肿瘤坏死增多，周围子灶的检出率增加22.1％；肿瘤与周围脏器的粘连增加，而肿瘤包膜形成增多、癌残留率显著降低（P＜ 0.05）；②A组的术中出血量和肝门阻断时间均较B组有不同程度增加，但差异无统计学意义，两组术后严重并发症比较差异无统计学意义（P ＞0.05）；③A组患者1、3、5年生存率和无瘤生存率为88.2％、53.0％、36.1％和65.7％、37.7％、30.4％；B组分别为68.8％、36.9％、25.1％和46.2％、24.4％、9.7％，两组差异有统计学意义（P＜ 0.05）。【结论】 术前TACE使难根治性切除大肝癌肿瘤缩小、包膜形成和癌残留减少，有效的提高大肝癌根治性切除率，延长实际生存期。 【关键词】? 癌，肝细胞； TACE； 肝切除术 ??? Efficacy of Second Stage Resection following Transcatheter Hepatic Arteria ??? Abstract:【Objective】To investigate the significance and efficacy of second stage resection following transcatheter hepatic arterial chemoembolization (TACE) in the patients with large hepatocellular carcinoma (HCC) of hardly radical excision.【Methods】The 143 enrolled large HCC patients were retrospectively divided into group A (preoperative TACE group, 68 cases) and group B (non-TACE group, 75 cases). The operative outcome, complications, tumor-residual rate, and survival rate were compared between the two groups. 【Results】 ①The rates of encapsulation and liver adhesions were significantly more in group A than in group B. There were fewer tumor-residual and more frequent necrosis in group A (P 0.05). ②The average time of clamping porta hepatis, blood loss, and postoperative complications did not differ between the two groups. ③The 1-, 3-, and 5-year overall survival rates and tumor-freely survival rates were 88.2%, 53.0%, 36.1% and 65.7%, 37.7%, 30.4% in group A, 68.8%, 36.9%, 25.1% and 46.2%, 24.4%, 9.7% in group B, respectively. There were significant differences between the two groups (P 0.05).【Conclusions】 TACE could diminish tumor, advance encapsulation and reduce tumor-residual. The preoperative TACE increases obviously the radical resection rate and improves the actual sur