动脉栓塞化疗与高强度聚焦超声联合治疗大肝癌的临床疗效

Clinical effect of transcatheter arterial chemoembolization combined with high intensity focused ultrasound ablation in treatment of large hepatocellular carcinoma

目的探讨动脉栓塞化疗（TACE）与高强度聚焦超声（HIFU）联合治疗大肝癌的临床应用疗效。方法68例原发性大肝癌患者分为两组：（1）TACE与HIFU联合组38例，在TACE治疗后2～3周，接受HIFU治疗；（2）单纯TACE组30例。肿瘤最大径5．0～14．5cm，平均（9．3±3．2）cm，总计88个瘤块，多发病灶者选其中最大径肿瘤为观察目标。两组病例的平均年龄、病灶大小、肿瘤TNM分期以及肝功能分级差异无统计学意义。全部患者随访3～24个月，平均（13±7）个月。观察治疗前后患者临床症状、肿瘤标志物（AFP）、肿瘤影像学（CT或MRI或PET）等变化，对患者进行随访以评估治疗后肿瘤凝固性坏死、肿瘤大小、局部复发率和生存预后。结果TACE与HIFU联合治疗后患者的临床症状缓解率为90．6％（29／32）。TACE与HIFU联合组的肿瘤坏死率为73．7％，肿瘤缩小率为68．4％，单纯TACE组分别为26．7％、33．3％，两组比较，差异有统计学意义（P〈0．01）。两组局部复发率分别为21.1％、33．3％，二者差异无统计学意义（P〉0．05）。联合组中位生存期为18个月，明显高于TACE组（10个月），二者差异有统计学意义（P〈0．05）。结论TACE与HIFU联合治疗大肝癌的疗效明显优于单纯TACE，可提高肿瘤坏死率并延长患者生存期。

Objective To investigate the clinical effect of transcatheter arterial ehemoembolization （TAKE） combined with high intensity focused ultrasound （HIFU） ablation in treatment of large hepatocellular carcinoma （HCC）. Methods Sixty-eight patients with unresectable HCC were randomized into 2 age, tumor size, TNM stages, and liver function grade-matched groups： TACE group （n = 30） undergoing TAKE and TAKE ＋ HIFU group （ n = 38） undergoing 2-3 weeks after TAKE. A total of 88 tumors （9. 3 ±3.2） （5. 0 - 14. 5） cm in diameter were detected, and the largest tumor in a specific patients with multiple lesions was selected for observation. Follow-up was conducted for （13 ± 7 ） （3 -24） months to observe the necrosis of tumor, size of tumor, local recurrence, and survival of patient. Results The clinical symptom remission rate was 90. 6% （29/32） in the TAKE ＋ HIFU group and 70. 8% （28/38） in the TAKE group. The tumor necrosis and minification rates of the TACE ＋ HIFU and TACE groups were 73.7% and 68.4% respectively, both significantly higher than those of TAKE group （26. 7% and 33.3% respectively, both P 〈0. 01）. The tumor local recurrence rate of the TACE ＋ HIFU group was 21.1% , not significantly different from that of the TACE group （33.3% , P 〉 0. 05 ）. The median survival duration of the TACE ＋ HIFU group was 18 months, significantly longer than that of the TAKE group （10 months, P 〈0. 05）. Conclusion Compared with the TACE therapy alone, the combination therapy improves the tumor necrosis rate and prolongs the patients＇ survival duration.