原发性肝癌不同治疗方法的疗效分析

Effects of different therapeutic methods for hepatocellular carcinoma

目的探讨不同治疗方法治疗原发性肝癌的临床效果。方法回顾性总结手术前后行经导管肝动脉化疗栓塞术(TACE)及行TACE后射频消融(RFA)、TACE或经导管肝动脉化疗灌注治疗(TAI)后中药和生物治疗的268例原发性肝癌患者的临床资料,分析各种治疗的疗效。结果 268例患者中156例患者获得随访,随访率58.2%。全组患者1、3、5年生存率分别为60.9%、32.7%和9.0%,其中术前行TACE和术后行TACE患者1、3、5年生存率分别为68.8%、41.7%、8.3%和64.7%、44.1%、23.5%,行TACE+RFA患者的1、3、5年生存率分别为66.7%、33.3%、11.1%,TACE患者的1、3、5年生存率分别为66.7%、19.0%和9.5%,行TAI患者的1、3、5年的生存率为11.8%和0、0。手术前后行TACE患者1、3、5年生存率最高,且两者比较,差异无统计学意义(P>0.01);行TACE患者1、3、5年生存率显著高于行TAI患者(P均<0.01)。行TACE+RFA、TACE患者近期疗效显著好于行TAI患者(P均<0.01)。行TACE+RFA、TACE与行TAI患者比较,其肝功能分级差异无统计学意义(P均>0.05),但瘤内血流信号消失、瘤周血流信号消失、AFP转阴率差异有统计学意义(P均<0.01)。结论原发性肝癌手术切除前、后行TACE治疗效果最佳;作为非手术治疗,TACE+RFA疗效优于TACE,TAI疗效较差。

Objective To evaluate the effects of different comprehensive interventional therapies for the hepatocellular carcinoma（HCC）.Methods The clinical datas of 268 patients with HCC treated by comprehensive interventional therapy of the transcatheter arterial chemoembolization（TACE） after or before hepatectomy,TACE combined with radio-frequency ablation（RFA）,Chinese medicine and biotherapy after TACE or the transcatheter arterial infusion（TAI） were reviewed,and the effects of different therapies were analyzed.Results Of 268 patients,156 patients were followed up.The overall 1,3,5 year survival rates were 60.9%,32.7% and 9.0% respectively;The 1,3,5 year survival rates of patients received TACE before or after hepatectomy were 68.8%,41.7%,8.3% and 64.7%,41.1%,23.5%,respectively;The 1,3,5 year survival rates of patients underwent TACE combined with RFA were 66.7%,33.3% and 11.1%,and the survival rates of patients received TACE,TAI were 66.7%,18.9%,10.5% and 117.7%,0,0.The survival rates of patients underwent TACE before or after hepatectomy were highest,and had no significant difference between them（all P0.05）;The 1,3,5 year survival rates of patients received TACE were higher than those of patients received TAI（all P0.01）.The short-term curative effects of patients received TACE,TACE combined with RFA were better than that of patients received TAI（all P0.01）.There were no significant differences in the degrade of liver function among the patients received TACE,TACE combined with RFA,TAI（all P0.05）.But compared with the patients received TAI,there were significant diferences in the AFP negative conversion rate,blood flow signals disappear in and around tumor for the patients underwent TACE,TACE combined with RFA（all P0.01）.Conclusions The therapeutic effects of TACE before or after hepatectomy are the best,and that of TACE combined with RFA is better than that of TACE,the effect of TAI is the worst.