三种微创治疗方法序贯联合治疗块状型肝细胞癌

Sequential Combination Therapy of Three Minimally Invasive Methods for the Treatment of Massive Hepatocellular Carcinoma

【目的】探讨序贯联合肝动脉化疗栓塞（TACE）与经皮瘤内注药、射频消融（RFA）治疗块状型肝细胞癌（HCC）的临床疗效。【方法】对26例块状型HCC患者，共计39个瘤灶，先行TACE术，根据术后复查情况序贯联合TACE、经皮瘤内注药和RFA继续治疗。观察患者术前、术后6个月各相关指标的变化。【结果]26例患者，共行TACE术59人次，经皮穿刺瘤内注药术31人次，RFA术28人次。术后6个月甲胎蛋白（AFP）较术前明显下降（P〈O．01）。术后3个月、6个月的肿瘤体积分别较术前明显缩小（P〈0．01）。术后3个月肿瘤完全坏死率为89．7％。术前、术后3个月、6个月的肝、肾功能和血常规均在正常范围。1、2、3年患者生存率分别为76．92％、61．54％、34．62％。【结论】序贯联合TACE与经皮瘤内注药、RFA是一种对块状型HCC有效和可行的治疗方法。

[Objective]To explore and evaluate the clinical effect of sequential combination therapy of hepatic arterial chemoembolization （TACE）, percutaneous intratumoral injection of drugs and radiofrequency ablation （RFA） in treating massive hepatocellular carcinoma（MHCC）. [Methods]After TACE was performed in 26 patients with MHCC including 21 males and 5 females（aged from 21~78 years）, sequential combination of intratumoral injection of drugs and RFA were performed due to reexaminatiqn. [Results]The 26 MHCC patients underwent a total of 59 times of TACE, 31 times of percutaneous intratumoral injection of chemotherapeutic drugs and 28 times of RFA. AFP at 6 months after operation decreased more significantly than that before operation（ P〈 0.01）. Compared with before operation, the tumor size at 3 and 6-month after operation was obviously reduced（ P 〈0.01）. The complete tumor necrosis rate at 3-month after operation was 89.7%. The liver, kidney function and routine blood test before operation and 3- and 6 month after operation were all in the normal range. The cumulative survival rate in 1-, 2- and 3-year were 76.92%, 61.54% and 34.62%, respectively. [Conclusion]Sequential combination of TACE, percutaneous intratumoral injection of chemotherapeutic drugs and RFA is an effective, feasible and minimally invasive for the treatment of MHCC.