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目的观察小剂量动脉栓塞化疗(TACE)治疗肝癌的临床效果。方法将2003-12~2014-08该科159例不能手术单病灶原发性肝癌患者随机分为小剂量TACE组94例(A组)和常规剂量TACE组65例(B组)。观察治疗前后两组患者临床症状、肿瘤标志物(AFP)、肿瘤影像学(CT或MRI)、肝功能等变化,评估治疗后临床症状缓解率、肿瘤缩小情况和生存预后。结果 A组、B组治疗后患者的临床症状缓解率分别为76.5%、63.0%,两组比较差异无统计学意义(P=0.065)。术后6个月肿瘤缩小有效率A、B组分别为25.5%(24/94)、29.2%(19/65),两组比较差异无统计学意义(χ2=0.266,P=0.605);A组与B组术前甲胎蛋白阳性例数分别为68例、46例,术后1个月甲胎蛋白下降超过50%的比例分别为55.8%(38/68)、52.2%(24/46),两组比较差异无统计学意义(χ2=0.152,P=0.695);术后1年生存率A组与B组分别为82.9%(78/94)、75.4%(49/65),两组比较差异无统计学意义(χ2=1.378,P=0.240)。A组肝功能ALT、AST术后第1、3、5天明显低于B组,差异均有统计学意义,术后第7天A组的ALT、AST基本正常,而B组仍高于正常。结论小剂量TACE治疗肝癌的疗效与常规剂量TACE无差异,且对肝功能的影响小。
Objective To observe the clinical effect of low-dose arterial chemoembolization (TACE) in the treatment of liver cancer. Methods A total of 159 patients with primary hepatocellular carcinoma of unresectable single lesions from December 2003 to August 2014 were randomly divided into two groups: 94 patients in the low dose TACE group (group A) and 65 patients in the conventional dose TACE group (group B). The clinical symptoms, tumor markers (AFP), tumor imaging (CT or MRI) and liver function were observed before and after treatment. The clinical symptom relief rate, tumor shrinkage and survival prognosis were evaluated after treatment. Results The remission rates of clinical symptoms of patients in group A and group B after treatment were 76.5% and 63.0%, respectively. There was no significant difference between the two groups (P = 0.065). The effective rate of tumor reduction at 6 months after operation was 25.5% (24/94) in group A and 29.2% (19/65) in group B, respectively. There was no significant difference between the two groups (χ2 = 0.266, P = 0.605) The positive number of preoperative alpha-fetoprotein in group B and group B were 68 cases and 46 cases, respectively. The proportion of alpha-fetoprotein decreased by more than 50% in one month after operation was 55.8% (38/68) and 52.2% (24/46) ), There was no significant difference between the two groups (χ2 = 0.152, P = 0.695). The postoperative 1-year survival rates were 82.9% (78/94) in group A and 75.4% (49/65) in group B The difference was not statistically significant (χ2 = 1.378, P = 0.240). The ALT and AST of group A were significantly lower than those of group B on the 1st, 3rd and 5th day after operation, the difference was statistically significant. On the 7th day after operation, the ALT and AST in group A were basically normal while those in group B were still higher than those in group B . Conclusion The efficacy of low-dose TACE in the treatment of liver cancer has no difference with the conventional dose of TACE, and has little effect on liver function.