伴失代偿肝硬化的肝癌患者综合介入治疗

Multi-interventional therapy for hepatocellular carcinoma with decompensated hepatic cirrhosis

目的探讨伴失代偿性肝硬化的原发性肝细胞癌（HCC）患者综合介入治疗临床价值。方法42例伴肝功能失代偿HCC患者在内科治疗稳定后接受肝动脉节段性化学栓塞治疗（S-TACE），并在1～2周内序贯射频消融（RFA）和无水乙醇局部注射（PEI）治疗。结果随访3—48月，甲胎蛋白（AFP）于术后2～4周开始下降，27例（70．00％）逐渐达到正常；3个月后肿瘤缩小50％以上者占54．76％（23／42）；中位生存期14．1月，6个月、12个月和24个月累计生存率分别为78．57％（33／42）、40．48％（17／42）和19．05％（8／42）；单变量分析显示，包括HBVDNA在内的14项因素与预后显著相关，多因素Cox模型分析显示，ICGR15、门静脉癌栓、治疗次数和AFP术前升高者介入后变化与预后显著相关。结论综合介入治疗是伴失代偿性肝硬化HCC的有效治疗方法，对HBVDNA阳性HCC患者介入前应考虑抗病毒治疗。

Objective To evaluate the efficiency of treatment for hepatocellular carcinoma with decompensated hepatic cirrhosis by muhi-lnterventional therapy. Methods 42 cases with hepatocellular carcinoma were treated with hyper-selective segmental transcatheter arterial chemo-embolization （S-TACE） and then radiofrequency ablation（RFA） and pereutaneous ethanol injection （PEI） with in 2 weeks. Univariate and multivariate Cox proportional hazard regression model were used to analyze the factors affecting the prognosis. Results All patients have been followed up for 3 months to 48 months, The median survival time was 14,1 months. The overall cumulative survival rates for 6,12 and 24 months were 78.57% （33/42） ,40.48% （17/42） and 19.05% （8/42） respectively. Univariate analysis identified 14 parameters （include HBV DNA） of prognostic significance. Multivariate analysis showed that Child-pugh classification, ICGR,5, portal cancerous thrombus, times of treatment and decrease in AFP concentration after treatment were significant factors. Conclusion The muhi-lnterventional therapy give better results for hepatocellular carcinoma with decompensated hepatic cirrhosis, and patients with positive HBV DNA should receive antivirus（hepatitis B） treatment.