術前輔助性肝動脈化療栓塞對巨塊型肝癌預后的影響

吳志榮　林妹妹

[摘要] 目的 評價術前輔助性肝動脈化療栓塞（transcatheter hepatic arterial chemoemb- olization，TACE）對巨塊型肝癌預后的影響。 方法 收集2010年1月～2015年3月收入院手術治療的31例巨塊型肝癌患者，均為經術后病理確診肝細胞性肝癌的病例，對該患者的資料進行回顧性分析，根據手術前是否行TACE術分組為一期手術組（n=21）與術前輔助性TACE術聯合降期手術組（n=10），兩組均行巨塊型肝癌切除手術，比較兩組的總體生存率與無瘤生存率。 結果 一期手術組和術前輔助性TACE術聯合降期手術組1、3年總體生存率分別為70.70%（7/10）、20.00%（1/5）和100.00%（10/10）、71.40%（5/7），平均生存時間分別為（45.429±5.122）個月和（26.399±4.658）個月，兩組術后生存率的差異有統計學意義（P=0.041）。兩組1年的無瘤生存率分別是26.67%（4/15）和75.00%（6/8），兩組術后無瘤生存率有統計學差異（P=0.031）。 結論 術前輔助性TACE術能使巨塊型肝癌的腫塊減小，增加手術切除機會，減少明顯的肝功能損害，降低手術難度，對術后恢復影響小，對提高巨塊型肝癌的術后總生存率及無瘤生存率有幫助。

[關鍵詞] 巨塊型肝癌;術前肝動脈化療栓塞;降期手術切除;預后

[中圖分類號] R735.7? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-9701（2019）11-0037-04

Effect of preoperative assisted transcatheter hepatic arterial chemoembolization on the prognosis of massive liver cancer

WU Zhirong1? ?LIN Meimei2

1.Department of General Surgery， Xiamen Hospital of Zhongshan Hospital Affliated to Fudan University， Xiamen 361000， China; 2.Department of Gastroenterology， Xiamen Hospital of Zhongshan Hospital Affliated to Fudan University， Xiamen? ?361000， China

[Abstract] Objective To evaluate the effect of preoperative assisted transcatheter hepatic arterial chemoembolization （TACE） on the prognosis of massive liver cancer. Methods Thirty-one patients with massive liver cancer who underwent surgical treatment from January 2010 to March 2015 were collected. All of these patients were diagnosed with hepatocellular carcinoma by postoperative pathology. The patients' data were retrospectively analyzed. According to whether TACE was performed before surgery， the patients were divided into one-stage operation group（n=21） and preoperative auxiliary TACE combined with descending-stage operation group（n=10）. Massive liver cancer resection was performed in all patients， and the overall survival rate and tumor-free survival rate were compared between the two groups. Results The 1-and 3-year overall survival rates of the two groups were 70.00%（7/10）， 20.00%（1/5）， and 100.00% （10/10）， 71.40% （5/7）， and the average survival time was （45.429±5.122） months and （26.399±4.658） months. There were statistically significant differences in postoperative survival rates between the two groups （P=0.041）. The 1-year tumor-free survival rates of the two groups were 26.67% （4/15） and 75.00% （6/8）， respectively， and the difference was statistically significant（P=0.031）. Conclusion Preoperative assisted TACE can reduce the mass of massive liver cancer， increase the chance of surgical resection， reduce obvious liver function damage， reduce the difficulty of surgery， with little effect on postoperative recovery， and can improve the postoperative total survival rate and tumor-free survival rate in patients with massive liver cancer.