超声引导下无水酒精、醋酸、热生理盐水、激光、射频及肝动脉化疗栓塞局部综合介入疗法治疗5～8 cm肝癌的疗效分析

Analysis on efficacy of ultrasound-guided multiple interventions on 5-8 cm liver cancer

目的 探讨超声引导下经皮瘤内注射酒精(PEI)、醋酸(PAI)、热生理盐水(PHSI)、间质性激光动力学疗法(IPDT)、射频消融(RFA)及肝动脉化疗栓塞(TACE)联合酒精或射频或激光局部综合介入疗法对5～8 cm肝癌患者的治疗疗效.方法 选择1992-2005年经上述6种介入方法治疗的肝癌患者204例,其中分别以酒精治疗66例、醋酸20例、热生理盐水20例、激光24例、射频30例、综合介入治疗44例,并与同期56例肝癌手术治疗患者的生存率和复发率进行比较. 结果 (1)6种方法介入治疗及手术治疗患者1、3、5年累计生存率比较均以外科手术组最高(91.9%、58.9%、35.7%);6种方法介入治疗患者1年生存率由高至低依次为酒精组(86.4%)、激光和射频组(83.3%)、综合治疗组(81.8%)、醋酸组(80.0%)、热生理盐水组(35.0%);3年生存率由高至低依次为醋酸组(55.0%)、综合治疗组(52.3%)、激光组(50.0%)、酒精组(48.5%)、射频组(46.7%)、热生理盐水组(20.0%);5年生存率由高至低依次为射频组(30.0%)、激光组(29.2%)、酒精组(25.8%)、醋酸组(25.0%)、综合治疗组(25.0%)、热生理盐水组(5.0%);热生理盐水组患者1、3、5年生存率最低且与其他治疗组比较差异有非常显著性 (P＜0.01),其余6组患者1、3、5年生存率比较差异均无统计学意义(P＞0.05);(2)热生理盐水组患者肝癌病灶局部复发率(75.0%)显著高于其余6组(P均＜0.05),手术治疗组(8.9%)与醋酸组(20.0%)局部复发率比较差异无统计学意义(P＞0.05),而显著低于其他5组(P均＜0.05);(3)各组治疗部位以外肝癌病灶复发率为62.5%～80.0%,组间比较差异无统计学意义 (P＞0.05).结论 除热生理盐水外,酒精、醋酸、激光、射频和局部综合介入治疗可作为无法切除大肝癌的治疗选择,若肿瘤血供丰富首选局部介入综合疗法;综合治疗,术后严密监测,及时补充治疗是提高疗效的关键.

Objective To investigate the efficacy of percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), percutaneous hot saline injection (PHSI), interstitial photodynamic therapy (IPDT), radiofrequency ablation (RFA), and local comprehensive intervention of transcatheter arterial chemoembolization(TACE) combined with PEI or RFA or IPDT on patients with 5-8 cm liver cancer. Methods A total of 204 patients with liver cancer were conducted by ultrasound-guided multiple interventions from 1992-2005 were enrolled as investigated objects. In 204 patients 66 patients were treated with PEI, 20 with PAI, 20 with PHSI, 24 with IPDT, 30 with RFA, and 44 with local comprehensive treatment. Their survival rate was compared with that of 56 patients undergone concurrently liver cancer operation. Results(1) Compared with other groups, the 1 st, 3 rd, and 5 th year cumulative survival rates of surgical operation were the highest (91.9%, 58.9%, 35.7% respectively). The 1st year cumulative survival rates of ultrasound-guided intervention groups were in descending order of PEI (86.4%), IPDT (83.3%), RFA (83.3%), local comprehensive treatment (81.8%), PAI (80.0%), PHSI (35.0%); and the 3rd year cumulative survival rates were in descending order of PAI (55.0%), local comprehensive treatment (52.3%), IPDT (50.0%), PEI (48.5%), RFA (46.7%), PHSI (20.0%); and the 5th year cumulative survival rates were in descending order of RFA (30.0%), IPDT (29.2%), PEI (25.8%), PAI (25.0%), local comprehensive treatment (25.0%), PHSI (5.0%). There were significant differences of survival rates between PHSI and the other therapies (P<0.01), and no significant differences of survival rates between the other groups (P>0.05); (2) The recurrence of PHSI group (75.0%) was significantly higher than those of the other groups (P<0.05). The operational group as the control group (8.9%) was significantly lower than those of PEI, PHSI, IPDT, RFA, and local comprehensive intervention group (P<0.05), but was not significantly different from that of PAI group (20.0%); (3)Follow-up by the 5th year, the recurrences at the sites beside the treated and metastatic sites varied 62.5%-80.0%; there were no significant differences between all groups (P>0.05).Conclusions (1) Except the PHSI, the other 5 methods may be selected for treating larger hepatic cancers (5-8 cm) which lost surgical indication. If the tumor vasculature is very rich, the first selection is comprehensive intervention; (2) Comprehensive sequential therapy, postoperative monitoring recurrence and reinforcing treatment in time were the essential points for improving the survival rate of patients with liver cancer.