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目的 探讨超声引导经皮穿刺荷瘤动脉栓塞化疗 (percutaneoustumor’sarterychemoembolization ,PACE)治疗进展期大肝癌的疗效和临床应用价值。方法 经病理确诊 43例进展期大肝癌 ,2 1例行PACE治疗 ,其中 ,9例为经股动脉插管肝动脉化疗栓塞 (transcatheterarterialchemoembolization ,TACE)疗效不满意者。对照组为同期行TACE治疗的 2 2例 ,比较两种方法的治疗效果。两组病例平均年龄、病灶大小以及肝功能分级无显著性差异。结果 PACE组行肿瘤动脉穿刺治疗 3 4次 ,穿刺成功率 91.2 % (3 1/3 4) ,无一例发生严重并发症。治疗后PACE组 5例缩小 ,占 2 3 .8% (5 /2 1) ,TACE组 10例缩小 ,占 45 .5 % (10 /2 2 ) ,两组肿瘤缩小率比较无明显差异 (P >0 .0 5 )。术后肝功能受损PACE组 7例 ,占 3 3 .3 % (7/2 1) ;TACE组 16例 ,占72 .7% (16/2 2 ) ,二者有显著统计学差异 (P <0 .0 5 )。PACE组平均生存期为 11.2个月 ,最长 1例存活 2 3个月 ;TACE组为 14 .6个月 ,最长 1例存活 3 6个月。结论 超声引导PACE术对肝功能损伤小可用于进展期大肝癌治疗 ,尤对TACE治疗无效者不失为一项补充治疗新技术 ,值得进一步深入研究。
Objective To investigate the efficacy and clinical value of percutaneous ultrasound-guided percutaneous tumor embolization (PACE) in the treatment of advanced hepatocellular carcinoma. Methods Forty-three cases of advanced hepatocellular carcinoma were confirmed by pathology and 21 cases underwent PACE. Among them, 9 cases were unsatisfactory with transcatheter arterial chemoembolization (TACE). The control group consisted of 22 patients undergoing TACE for the same period. The treatment effects of the two methods were compared. There was no significant difference in the average age, lesion size, and liver function grade between the two groups. Results In the PACE group, the arterial puncture was performed 34 times. The success rate of puncture was 91.2% (3 1/3 4). No serious complication occurred. After treatment, 5 patients in the PACE group shrank, accounting for 23.8% (5/21), and 10 patients in the TACE group shrank, accounting for 45.5% (10/22). There was no significant difference in tumor reduction between the two groups (P >0 .0 5 ). Postoperative liver function impairment occurred in 7 patients in the PACE group, accounting for 33.3% (7/2 1); in the TACE group, 16 patients accounted for 72.7% (16/2 2). There was a significant difference between the two groups (P <0 .0 5 ). The average survival time in the PACE group was 11.2 months. The longest survival was 23 months; the TACE group was 14.6 months, and the longest one survived 36 months. Conclusion Ultrasound-guided PACE can be used for the treatment of advanced hepatocellular carcinoma with less damage to liver function, especially for TACE-ineffective treatment. It is worthy of further study.