TACE联合氩氦刀冷冻术治疗巨块型肝细胞癌的临床研究

Transcatheter arterial chemoembolization combined with Argon-Helium cryoablation for the treatment of hepatocellular carcinoma of giant lump type:a clinical study

目的探讨TACE采用联合氩氦刀冷冻术治疗巨块型肝细胞癌的疗效。方法收集湖南省肿瘤医院2001年1月-2007年5月采用TACE联合氩氦刀冷冻消融治疗病灶大于5 cm肝细胞癌56例(治疗组),并筛选同期在性别、年龄、病理等无显著差异的单纯TACE治疗的例数相同的病例(对照组)。分析比较两组1、2、3年生存率,治疗前后临床症状的改善,肝功能、血清肿瘤标志物(AFP)和肿瘤影像学改变(CT或MRI)。结果治疗组1、2、3年生存率分别为74.5%、68.4%和40.7%。平均生存期21个月,3个月临床症状缓解率为80.4%。6个月内CT、MRI提示治疗组病灶完全坏死者占15.5%,病灶明显缩小者占53.5%。对照组1、2、3年生存率为52.5%、44.1%和28.1%,平均生存期13个月,3个月临床症状的缓解率为57.1%。6个月内对照组CT、MRI提示病灶完全坏死者占7.9%,病灶明显缩小者占28.8%。两组间差异均有统计学意义(P值均<0.05)。结论 TACE联合氩氦刀冷冻消融是治疗巨块型肝细胞癌是一种有效的联合治疗方法,近期疗效明显,为巨块型肝细胞癌提供了新的治疗途径。

Objective To discuss the therapeutic value of transcatheter arterial chemoembolization（TACE） combined with Argon-Helium cryoablation in treating the hepatocellular carcinoma of giant lump type.Methods A total of 112 patients with giant lump hepatocellular carcinoma（HCC）,encountered in author＇s hospital during the period of January 2001 to May 2007,were enrolled in this study.The study group included 56 HCC patients with a giant lump sized over 5cm and TACE combined with Argon-Helium cryoablation was carried out.A comparable control group had 56 HCC patients,who received TACE only.All the patients were followed up regularly,the survival rate at 1,2 and 3 years was calculated.The improvement of clinical symptoms,the liver function tests,the serum tumor marker（AFP） and imaging findings（CT or MRI） were determined and observed.The results were analyzed and compared.Results During the follow-up period of 12-36 months,the survival rate at 1,2 and 3 years in study group was 74.5%,68.4% and 40.7% respectively with a mean survival rate of 21 months.Three months remission rate of clinical symptoms was 80.4%.The serum tumor marker（AFP） returned to normal in 42.6% patients and an obvious decrease of AFP was seen in 54.3% patients within 6 months.In the control group,the survival rate at 1,2 and 3 years was 52.5%,44.1% and 28.1% respectively with a mean survival rate of 13 months.The AFP returned to normal in 24.3% patients and an obvious decrease of AFP was seen in 48.6% patients within 6 months.Complete necrosis of the tumor was found in 7.9% patients and in 28.8% patients the tumor shrunk significantly on CT scan or MRI.The difference in the survival rate at 1,2 and 3 years,in the improvement of clinical symptom,in AFP level and in the imaging manifestations between two groups was of statistical significance,while no significant difference in main liver function tests existed between two groups.Conclusion TACE combined with Argon-Helium cryoablation is an effective and comprehensive treatment for giant lump HCC with distinct short-term effectiveness,this technique provides a new alternative for the treatment of giant lump HCC.