本文選題：原發(fā)性肝癌 + 化療栓塞��； 參考：《青島大學》2015年碩士論文

【摘要】：目的:探討恩度聯(lián)合TACE不同用藥方案對中晚期原發(fā)性肝癌血清VEGF表達對比分析。方法:選擇均有肝臟病理穿刺結果證實或符合原發(fā)性肝癌的臨床診斷標準的60例中晚期肝癌患者,60名患者隨機分為二組,A組,對照組,30例(恩度聯(lián)合TACE動脈灌注栓塞組);B組,實驗組,30例(恩度聯(lián)合TACE動脈灌注栓塞并術后靜脈滴注組)。A組(對照組):術中首先將導管選擇至腫瘤病灶的供血靶動脈行灌注治療,緩慢手推注射器灌注恩度15mg、奧沙利鉑50mg及注射用鹽酸表柔比星30mg,再將恩度15mg與5~15ml超液態(tài)碘化油(用量據(jù)病灶大小而定)通過T型三通旋轉(zhuǎn)閥門充分乳化,后在透視下緩慢栓塞腫瘤病灶及供血靶血管。B組(實驗組):手術方式及化療栓塞藥物選擇同A組,不同在于術后第一天開始靜脈滴注恩度,連續(xù)滴注7天,用法:將30mg恩度加入500ml0.9%Na Cl中緩慢靜脈滴注。全組60例患者分別于術前1天,術后3天、7天、15天、30天各抽取空腹靜脈血3ml,通過酶聯(lián)免疫吸附實驗法檢測60例患者血清中血管內(nèi)皮生長因子(VEGF)的表達水準并統(tǒng)計分析,隨訪記錄觀察術后并發(fā)癥。結果:1.ELISA法檢測結果示:A、B兩組患者術前1天血清中VEGF表達水準相比較差異不明顯(P0.05)。A、B兩組患者術后第三天血清中VEGF水平都升高并達最高值,術后7天、15天、30天血清中VEGF表達水準表現(xiàn)為持續(xù)緩慢減低且均低于術前水準,術后A、B兩組各個時段血清中VEGF表達水準與術前相比較差異顯著(P0.05)。方差分析結果示:A、B兩組術后各時段血清中VEGF表達水準相比較差異顯著(P0.05)且實驗組VEGF表達水準明顯低于對照組。2.恩度并發(fā)癥:A、B組均出現(xiàn)一過性轉(zhuǎn)氨酶升高,輕度黃疸,惡心嘔吐等TACE術后綜合征,A、B組各有3例患者出現(xiàn)胸悶不適,但均無心電圖改變,兩組患者均未發(fā)現(xiàn)鼻出血、心律失常等不良反應。兩組患者中恩度相關并發(fā)癥的發(fā)生比較無顯著差異(P0.05)。結論:1.恩度聯(lián)合TACE治療原發(fā)性肝癌能夠顯著降低血清中VEGF表達水準。2.恩度聯(lián)合TACE并術后靜脈滴注用藥方式較單純恩度聯(lián)合TACE動脈灌注栓塞為優(yōu)。
[Abstract]:Objective: to investigate the expression of serum VEGF in patients with advanced hepatocellular carcinoma (HCC) treated with Endol combined with TACE. Methods: sixty patients with advanced liver cancer were randomly divided into two groups: group A (n = 30) and group B (n = 30). Experimental group (n = 30) (Endol combined with TACE artery infusion embolization and intravenous infusion after operation). Group A (control group): the catheter was first selected to the target artery of the tumor focus during the operation for perfusion therapy. Slow hand push injector infused Endol 15mg, oxaliplatin 50mg and epirubicin hydrochloride 30mg for injection, then emulsified Endor 15mg and 5~15ml super-liquid iodized oil (depending on the size of the lesion) through T-type three-way rotary valve. Then the tumor focus and blood supply target vessels were slowly embolized under fluoroscopy. Group B (experimental group: operation method and chemoembolization drug selection was the same as group A, the difference was that the first day after operation, intravenous infusion of Endol, 7 consecutive days), Usage: add 30mg Endol to 500ml0.9%Na Cl by slow intravenous drip. Fasting venous blood samples were collected from 60 patients 1 day before operation, 3 days after operation and 15 days to 30 days after operation. The expression level of vascular endothelial growth factor (VEGF) in serum of 60 patients was detected by enzyme linked immunosorbent assay (Elisa) and analyzed statistically. Postoperative complications were observed by follow-up records. Results 1. The results of Elisa showed that there was no significant difference in the level of VEGF expression between the two groups on the first day before operation. The serum VEGF level of the two groups increased to the highest level on the third day after operation. The expression level of VEGF in serum from 7 days to 15 days to 30 days after operation was decreased slowly and was lower than that before operation. The level of VEGF expression in serum of group A and B was significantly different from that before operation (P 0.05). The results of ANOVA showed that the level of VEGF expression was significantly lower in the two groups than that in the control group (P 0.05) and the level of VEGF expression in the experimental group was significantly lower than that in the control group (P 0.05). There were 3 cases of chest tightness in each group with mild jaundice, nausea and vomiting, but no changes in electrocardiogram. No epistaxis was found in both groups. Adverse reactions such as arrhythmia. There was no significant difference in the incidence of Endodendron related complications between the two groups (P 0.05). Conclusion 1. Endol combined with TACE in the treatment of primary liver cancer can significantly reduce the level of VEGF expression in serum. 2. 2. Endor combined with TACE and intravenous infusion after operation was better than simple Endol combined with TACE arterial infusion embolization.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.7

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本文編號：1944300