论文部分内容阅读
目的探讨肝动脉化疗栓塞(transarterial chemoembolization,TACE)联合FOLFOX方案(奥沙利铂+亚叶酸钙+脱氧氟尿苷)动脉留管灌注治疗巴塞罗那临床肝癌分期B期(Barcelona Clinic Liver Cancer Stage B,BCLC-B)原发性肝癌的近期疗效和安全性。方法 62例BCLC-B期原发性肝癌患者依据治疗方法分为观察组29例和对照组33例,对照组应用奥沙利铂100mg+脱氧氟尿苷1 000mg动脉灌注15min后,应用奥沙利铂50mg+超液化碘油行TACE治疗;观察组应用脱氧氟尿苷1 000mg动脉灌注15min,应用奥沙利铂50mg+超液化碘油行TACE治疗,之后静脉滴注亚叶酸钙300mg,完毕后序贯泵入奥沙利铂100mg(时间2h),脱氧氟尿苷2 000mg(时间44h),泵入脱氧氟尿苷前静脉滴注亚叶酸钙300 mg。2组均每4周治疗1次,连续治疗4次后评价近期疗效,观察谷丙转氨酶(glutamic-pyruvic transaminase,GPT)、谷草转氨酶(glutamic-oxaloacetic transaminase,GOT)、总胆红素(total bilirubin,TBil)及直接胆红素(direct bilirubin,DBil)水平变化,记录不良反应发生情况。结果观察组近期有效率(79.31%)、临床获益率(93.11%)均高于对照组(54.55%,72.73%)(P<0.05);对照组、观察组治疗后GPT[(53.8±1.5)、(54.5±2.2)u/L]、GOT[(65.2±2.7)、(66.4±3.6)u/L]、TBil[(20.7±1.1)、(21.1±0.8)μmol/L]及DBil[(8.1±0.8)、(7.6±1.3)μmol/L]均较治疗前[GPT:(47.5±3.9)、(46.9±2.5)u/L,GOT:(41.6±2.7)、(42.9±3.5)u/L,TBil:(18.7±1.9)、(19.5±1.2)μmol/L,DBil:(6.1±0.7)、(5.7±0.7)μmol/L]增高,差异有统计学意义(P<0.05);2组治疗后各指标比较差异无统计学意义(P>0.05);观察组Ⅰ~Ⅱ度恶心呕吐发生率(37.93%)及Ⅰ度骨髓抑制发生率(75.86%)与对照组(39.39%,72.73%)比较差异无统计学意义(P>0.05)。结论 TACE联合FOLFOX方案留管动脉灌注治疗BCLC-B期原发性肝癌的疗效优于TACE治疗,且不增加不良反应发生率。
Objective To investigate the effect of transarterial chemoembolization (TACE) combined with FOLFOX regimen (oxaliplatin + leucovorin plus deoxyfluorouridine) for the treatment of Barcelona Clinic Liver Cancer Stage B (BCLC) -B) Short-term efficacy and safety of primary liver cancer. Methods Sixty-two patients with BCLC-B primary hepatocellular carcinoma were divided into observation group (n = 29) and control group (n = 33). The control group was given oxaliplatin 100mg and deoxyfluorouridine 1000mg for 15 minutes, Platinum 50mg + liquefied iodized oil line TACE treatment; observation group application of deoxyfluorouridine 1000mg arterial perfusion 15min, the use of oxaliplatin 50mg + liquefied iodized oil TACE treatment, followed by intravenous infusion of leucovorin 300mg, after the completion of sequential Pooled oxaliplatin 100mg (time 2h), deoxyfluorouridine 2 000mg (time 44h), before infusion of doxifluridine leucovorin 300 mg. The two groups were treated once every four weeks and four times consecutively. The curative effect was evaluated. The levels of glutamic-pyruvic transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), total bilirubin , TBil) and direct bilirubin (DBil) levels were recorded, and the incidence of adverse reactions was recorded. Results The effective rate (79.31%) and clinical benefit rate (93.11%) in the observation group were significantly higher than those in the control group (54.55% and 72.73%, P <0.05) (54.5 ± 2.2) u / L, GOT 65.2 ± 2.7 66.4 ± 3.6 u / L, TBil 20.7 ± 1.1 21.1 ± 0.8 μmol / L and DBil [ (47 ± 3.9), (46.9 ± 2.5) u / L, GOT: (41.6 ± 2.7), (42.9 ± 3.5) DBil: (6.1 ± 0.7) and (5.7 ± 0.7) μmol / L, respectively) were significantly higher than those in control group (P <0.05) (P> 0.05). The incidence of grade Ⅰ ~ Ⅱ degree nausea and vomiting (37.93%) and grade Ⅰ myelosuppression (75.86%) in the observation group were significantly higher than those in the control group (39.39% , 72.73%) compared with no significant difference (P> 0.05). Conclusions The TACE combined with FOLFOX regimen of arterial infusion in the treatment of BCLC-B stage of primary liver cancer is better than TACE in treatment of liver cancer, and does not increase the incidence of adverse reactions.