全身热疗法治疗晚期肝脏恶性肿瘤39例报告

Whole Body Hyperthermia in Treatment of 39 Cases of Advanced Hepatic Carcinoma

目的 探讨全身热疗法（whole body hyperthermia，WBH）治疗肝脏恶性肿瘤的疗效及其对肝功能的影响。方法 采用WBH治疗肝脏恶性肿瘤患者39例，并对治疗前、后患者肝功能指标进行动态观察，分析该疗法对肝脏功能的影响，并通过分析治疗效果，初步评估该疗法的疗效。结果 ①WBH治疗不能手术切除的晚期肝脏恶性肿瘤患者的有效率为61．5％（24／39），60．0％（9／15）的患者AFP有不同程度下降，肿瘤疼痛缓解率达100％；存活期〉2年者占12．8％（5／39），〉1年者占59．0％（23／39），〉6个月者占76．9％（30／39）。②谷丙转氨酶于治疗后1～3d出现明显升高（P〈0．05），7d后下降并接近治疗前水平；谷草转氨酶于治疗后1d明显升高（P〈0．05），3～7d则下降并接近治疗前水平；白蛋白于治疗后1d出现下降（P〈0．05），但3d即已恢复；肝功能正常组总胆红素于治疗后第1～3d出现升高（P〈0．05），而肝功能异常组未观察到同样变化；转肽酶则无明显变化。结论 WBH能改善晚期肝脏恶性肿瘤患者的预后，提高生存质量，延长生存时间，但同时可造成患者肝功能一定程度的可逆性损害。

Objective To evaluate the efficacy of whole body hyperthermia （WBH） in the treatment of advanced hepatic carcinoma and its effect on liver function. Methods From 2001 to 2004, 39 cases of advanced hepatic carcinoma were treated with WBH. The effect of WBH on liver function was assessed by liver function test before and after treatment. Results ① The effective rate of WBH was 61.5 % （24/39） in the treatment of advanced hepatic carcinoma with declined AFP in 60.0% （9/15） of patient and 100% of patients had pain relieve. The survival rates of 6 months, 1 year and 2 years were 76.9% （30/39）, 59.0% （23/39） and 12.8% （5/39）, respectively. ②Alanine aminotransferase （ALT） elevated obviously in 1-3 d after treatment （P〈0.05）, and then approached to its baseline in 7 d. Aspartate aminotransferase （AST） increased significantly 1 d after treatment （P〈0.05） ,and then back to its baseline in 3-7 d. Albumin （ALB） appeared dropped 1 d after treatment （P〈0.05）, and restored normally in 3 d. The levels of total bilirubin （TBIL） and gamma glutamyl transpeptidase （GGT） had no evident significant change with the WBH treatment in abnormal liver function group, but TBIL increased 1-3 d after treatment in normal liver function group （P〈0.05）. Conclusion In the treatment of advanced hepatic carcinoma, WBH can improve the patients＇ life quality and prolong their life expectancy. Meanwhile, it could also result in reversible impairment of liver function.