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目的分析I~(125)放射粒子植入联合肝动脉化疗栓塞(TACE)治疗老年大肠癌肝转移的临床疗效,评价其安全性。方法选取120例老年大肠癌肝转移患者,按照随机数字表法分为观察组和对照组,每组60例,均行TACE治疗,观察组加用I~(125)放射粒子植入。比较两组患者治疗前后肿瘤直径、肝功能、癌胚抗原(CEA)、糖蛋白199(CA199)、生活质量变化,观察其不良反应发生情况、1年无进展生存率,评价两种治疗方案的临床疗效与安全性。结果两组患者术后谷丙转氨酶、谷草转氨酶和γ-谷氨酰转肽酶均未见明显变化,差异无统计学意义(P>0.05),两组患者术后肿瘤最长径、CEA、CA199均较术前下降,术后12个月生活质量评分均较术前升高,观察组变化更为明显,差异有统计学意义(P<0.05)。两组患者术后并发症以白细胞降低、体温升高为主,多集中于术后1~3 d,经对症处理后均好转;两组患者术后均未见肝脓肿、腹膜炎等严重不良反应发生。观察组临床总有效率、1年无进展生存率高于对照组,差异有统计学意义(P<0.05)。结论在TACE的基础上联合I~(125)放射粒子植入,能提高大肠癌肝转移的治疗效果、延长患者无进展生存时间,且安全性良好。
Objective To analyze the clinical efficacy of I ~ (125) radioactive particle implantation combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatic metastasis of elderly patients with colorectal cancer and to evaluate its safety. Methods 120 cases of elderly patients with liver metastasis of colorectal cancer were divided into observation group and control group according to the random number table method. Each group had 60 cases treated with TACE. The observation group received I ~ (125) radioactive particle implantation. Tumor diameter, liver function, carcinoembryonic antigen (CEA), glycoprotein 199 (CA199), quality of life of the two groups before and after treatment were compared, the incidence of adverse reactions, the 1-year progression-free survival rate, the evaluation of two treatment options Clinical efficacy and safety. Results There was no significant difference in ALT, AST and GGT between the two groups after operation (P> 0.05). The longest tumor diameter, CEA, CA199 decreased compared with that before operation. The quality of life score of 12 months after operation was higher than that before operation, and the change of the observation group was more obvious. The difference was statistically significant (P <0.05). Two groups of patients with postoperative complications of leukopenia, elevated body temperature, mostly concentrated in 1 to 3 days after the symptomatic treatment were improved; two groups of patients were no postoperative liver abscess, severe adverse reactions such as peritonitis occur. The total effective rate of observation group, 1-year progression-free survival rate was higher than the control group, the difference was statistically significant (P <0.05). Conclusions The combination of I ~ (125) radioactive particle implantation on the basis of TACE can improve the therapeutic effect of liver metastasis of colorectal cancer, prolong the progression-free survival time of patients and have good safety.