高强度聚焦超声联合肝动脉栓塞治疗原发性肝癌56例

Clinical study of HIFU combined with transcatheter arterial chemoembolization in treatment of 56cases of primary liver cancer

目的 探讨高强度聚焦超声(HIFU)联合肝动脉化疗栓塞(TACE)治疗原发性肝癌(肝癌)的临床疗效.方法 106例肝癌患者分为两组,单纯TACE组50例(碘油栓塞或碘油栓塞联合5-氟尿嘧啶+多柔比星),联合组56例(HIFU+TACE).观察两组治疗后3个月的临床疗效和血清甲胎蛋白(AFP)的变化情况,观察两组患者的1、2、3年生存率.结果 单纯TACE组:CR0,PR20%,SD 52%;联合组:CR0,PR26.8%,SD 55.4%.AFP变化情况,单纯TACE组和联合组由治疗前的(472.3±104.2)μg/L和(491.8±125.2)μg/L,降为治疗后的(122.3±64.6)μg/L和(71.2±35.1)μg/L.1、2、3年生存率:联合组为82.3%、60.8%、39.2%;TACE组为68.0%、42.6%、21.0%.未发生皮肤烧伤、出血、胃肠道穿孔等并发症.结论 HIFU联合TACE是治疗肝癌的一种新的安全有效的治疗方法,可以明显延长肝癌患者的生存期,并且优于单纯TACE治疗.

Objective To explore the clinical effect of high intensity focused ultrasound(HIFU)combined with transcatheter arterial chemoembolization(TACE)in the treatment of primary liver cancer.Methods A total of 106 patients with primary liver cancer were divided into two groups:50 cases were treated with TACE,and the other 56 were treated with combination of HIFU and TACE.The changes of AFP levels and the size of tumors after three months treatment were analyzed and compared with each other.The survival rates for one,two and three years were calculated with Kaplan-Meier method and compared between the two groups.Results In the two groups,AFP decreased significantly after treatment,but the combined group was superior to the other in AFP decrease.In the combined group,the 1-,2-and 3-year survival rates were higher than those in the TACE group with 82.3%,60.8%and 39.2% vs 68.0%,42.6%and 21.0%respectively(P＜0.01).No serious complications were seen,such as burn of skin,bleeding,gastrointestinal perforation. Conclusion The use of HIFU combined with TACE in the treatment of patients with primary liver cancers is feasible and safe.The combined group is superior to simple TACE for the management of primary liver cancers,and the former is more effective in decreasing AFP level and improving survival rates.