较大体积肝癌肝动脉化疗栓塞联合微波消融或射频消融治疗82例对比观察  被引量：9

作　　者：刘华江 邓堂[1] 金桂云[1] LIU Hua-jiang;DENG Tang;JIN Gui-yun(Department of Interventional Therapy,First Affiliated Hospital of Hainan Medical University,Haikou 570100,P.R.China)

机构地区：[1]海南医学院第一附属医院介入治疗科,海南海口570100

出　　处：《中华肿瘤防治杂志》2020年第18期1522-1528,共7页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的局部消融联合肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗较大体积肝癌的综合模式与单一治疗模式相比,可获得更好的疗效及安全性,但具体采用何种消融方式联合肝动脉栓塞化疗治疗较大体积肝癌能取得更好的疗效,尚缺乏文献报道。本研究探讨微波消融(microwave ablation,MWA)对比射频消融(radiofrequency ablation,RFA)分别联合TACE治疗较大体积肝癌的疗效与安全性。方法选取2014-01-01-2015-12-01海南医学院第一附属医院82例接受TACE治疗的肝细胞癌(hepatocellular carcinoma,HCC)患者作为研究对象,按照微创方法分为MWA联合组(n=42)和RFA联合组(n=40)。比较2组的完全坏死率、近期疗效、局部复发率、总体生存率和治疗并发症发生率等指标,观察2组治疗前后血清甲胎蛋白(alpha fetoprotein,AFP)和肝功能(ALT、AST、TBil和DBil)的变化情况。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验或Fisher确切概率法;生存分析采用KaplanMeier法绘制生存曲线图,并采用Log-rank法进行组间比较。结果对直径≥5cm的肝癌,MWA联合组的完全坏死率高于RFA联合组(χ2=4.340,P=0.037),而对于直径3~5cm的肝癌,2组的完全坏死率比较差异无统计学意义,χ2=1.146,P=0.470。MWA联合组的控制率优于RFA联合组(χ2=5.030,P=0.025),但2组有效率差异无统计学意义,χ2=1.884,P=0.170。治疗1周后,RFA联合组的AFP、ALT、AST和TBil水平均低于MWA联合组,差异有统计学意义,P<0.05。治疗3个月后,RFA联合组的AFP、ALT、AST、TBil和DBil水平均低于MWA联合组,差异有统计学意义,P<0.05。2组局部复发率、总体生存率和治疗并发症的发生率差异均无统计学意义,P>0.05。结论 MWA联合TACE治疗模式治疗较大体积肝癌的完全坏死率和有效率更佳,但RFA联合TACE所造成的肝功能损伤更轻微。OBJECTIVE The comprehensive model of local ablation combined with hepatic arterial chemoembolization for the treatment of large-volume hepatocellular carcinoma(HCC)can achieve better efficacy and safety than the single mode.However,which ablative method can achieve better efficacy in the combination of transcatheter arterial chemoembolization(TACE)for treating HCC with large volume has not been reported.This study aimed to compare the clinical efficacy between microwave ablation(MWA)combined with TACE and radiofrequency ablation(RFA)combined with TACE in the treatment of HCC with large volume.METHODS Eighty-two patients with primary HCC who underwent TACE in the First Affiliated Hospital of Hainan Medical College from January 1,2014 to December 1,2015 were divided into two groups according to the micro-invasive treatments approach,namely,MWA plus TACE group(n=42)and RFA plus TACE group(n=40).The complete necrosis rate,short-term curative effect,local recurrence rate,overall survival(OS)rate and complication incidence were compared between these two groups.The level of alpha fetoprotein(AFP),alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TBil)and direct bilirubin(DBil)were also compared at different time points.The t test was used in the comparison between groups for the continuous data,while theχ~2 test or Fisher’s exact probability method were used for the enumeration data.The Kaplan-Meier method was applied to draw the survival curve,and the Log-rank method was used in the comparison between groups.RESULTS For patients with a diameter greater than 5 cm,the complete necrosis rate was much higher in the MWA plus TACE group rather than the RFA plus TACE group(χ~2=4.340,P=0.037).But there was no statistical significance between these two groups(χ~2=1.146,P=0.470)in patients with a 3-5 cm tumor diameter.The control rate in the MWA plus TACE group rather was better than that of the RFA plus TACE group(χ~2=5.030,P=0.025),but there was no significant difference in the efficacy rate between

关 键 词：肝癌 微波消融 射频消融 肝动脉栓塞化疗 临床疗效 

分 类 号：R735.7[医药卫生—肿瘤]