原发性肝癌不同介入方案治疗后生命质量的评价

Quality of life of primary hepatocellular carcinoma patients after radiofrequency ablation with or without transcatheter arterial chemoembolization.

目的 观察原发性肝癌（HCC）经皮射频消融（RFA）治疗后生命质量的情况。方法 采用国内肝癌特异性生命质量量表（QOL-LC V2．0），对88例经RFA治疗，72例经动脉插管栓塞化疗（TACE组）以及49例TACE＋RFA（联合治疗组）治疗HCC患者，分别进行生命质量评定。结果 RFA组生命质量总分中位数（167，6）高于TACE组（145．7）（P〈0.01）；RFA组和联合治疗组在症状／副作用领域的得分中位数47．5、45．0，均优于TACE组的37．2（均P〈0.01）；RFA组躯体功能领域得分高于TACE组趋势（P=0．047）：TACE组和联合治疗组Child-Pugh分级提高的比例均高于RFA组（均P〈0．01）；TACE组并发症发生率、肿瘤复发／新生率明显高于RFA组（均P〈0．05）。结论 RFA作为一种肝癌局部微创治疗方法，多数患者在获得较好疗效的同时，可避免严重副作用，减少躯体功能损伤，有较高的整体生命质量。适当地选择TACE与RFA联合治疗与单纯TACE相比，可减少肝功能损伤，有利于提高原发性肝癌患者的生命质量。

Objective To evaluate the quality of life （QOL） of primary hepatocellular carcinoma （HCC） patients after radiofrequency ablation （RFA） , comparing with that of patients after transcatheter arterial chemoembolization （TACE） and TACE combined with RFA. Methods A QOL questionnaire special for HCC patients was used in 209 HCC patients after two months treatment,in which 88 patients underwent RFA （ RFA group） ,72 patients underwent transcatheter arterial chemoembolization （ TACE group） and 49 patients underwent both TACE and RFA （ TACE ＋ RFA group ）. Results The median of overall score of RFA group （ 167, 6 ） was higher than that of TACE group （ 145, 7 ） （ P 〈 0.01 ）. Especially, RFA group and TACE ＋ RFA group were better than TACE group in symptom/side effect {47.5,45 vs. 37, 2） （P 〈 0.01）. RFA group had a tendency of higher physical scores than TACE group （ P = 0,047 ）. The proportion of liver function damage was higher in TACE group and combination group than that in RFA group respectively. TACE group had more complications and tumor recurrence after treatment than RFA group and TACE ＋ RFA group（ P 〈 0.01 ）. Conclusion Radiofrequency ablation provides an effective and microinvasive method of killing liver tumors. The overall QOL score of HCC patients after RFA treatment is maintained at a relatively higher level than after TACE treatment. RFA is superior to TACE in physical and symptom/side effects. The combination of RFA and TACE appears to be effective and reveals a favorable outcome for HCC