肝动脉化疗栓塞术后联合高能聚焦超声治疗晚期肝癌80例临床研究

Clinical analysis of TACE and HIFU for treating advanced liver cancer in 80 cases

目的为了研究肝动脉化疗栓塞(TACE)术后联合高能聚焦超声(HIFU)治疗对晚期肝癌患者的疗效分析及评价。方法筛选2007年1月至2011年8月期间的80例晚期肝癌患者,其中单一行TACE治疗的分为A组;TACE术后联合HIFU治疗的分为B组。评估和比较两组患者术后临床疗效、肝功能、甲胎蛋白(AFP)、MRI和CT的效果。结果在A组中无严重的并发症。在B组中有一例中度发热,一例皮肤灼伤。TACE术前和术后丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)在A组中分别是ALT(59.8±45.9)U/L,AST(76.9±55.5)U/L和ALT(86.7±59.2)U/L,AST(73.7±49.8)U/L;在B组中分别是ALT(63.4±56.8)U/L,AST(72.5±46.6)U/L和ALT(54.3±30.8)U/L,AST(58.3±27.6)U/L,差异有统计学意义(P<0.05)。在A组中,术前AFP是(943.1±411)ng/mL,只有6例患者复查AFP(942.8±468.5)ng/mL,差异无统计学意义(P>0.05)。在B组中,术前和术后AFP的中位数分别是621.8ng/mL和16.2ng/mL,差异有统计学意义(P<0.05)。术后MRI和CT结果显示肿瘤靶区出现凝固性坏死、血供的减少和中断。术后两组临床疗效显效率、有效率、无效率分别是11.4%,65.7%,22.9%和28.9%,62.2%,8.9%,差异有统计学意义(P<0.05)。结论 TACE术后联合HIFU治疗晚期肝癌的临床疗效优于单一的TACE治疗。经治疗后患者肝功能、AFP在一定程度上得到改善,MRI和(或)CT结果显示经治疗后肿瘤大小在一定程度上有缩小,肿瘤区域出现凝固性坏死和肿瘤血供的减少和消失。

Objective To evaluate the efficacy of transcatheter arterial chemoembolization（TACE） and high-intensity focused ultrasound（HIFU） in the treatment of advanced hepatocellular carcinoma（HCC）.Methods From January 2007 to August 2011,80 patients with advanced hepatocellular carcinoma were selected and divided into two groups：group A（n=35）,in which patients received TACE only;and group B（n=45）,in which HIFU was performed followed by TACE.Immediate therapeutic effects were assessed at the basis of clinical efficacy,liver enzymes test,AFP,MRI,and CT before and after the treatments.Results No severe complications was observed in group A,and in group B,one patient got fever and one got skin hurt.In group A,ALT was（59.8±45.9） U/L,and AST was（76.9±55.5）U/L before TACE treatment,while ALT was（86.7±59.2）U/L,and AST was（73.7±49.8）U/L one-two weeks after the treatment.In group B,ALT was（63.4±56.8）U/L,and AST was（72.5±46.6）U/L before the TACE-HIFU treatment,while ALT was（54.3±30.8）U/L,and AST was（58.3±27.6）U/L after the treatment（P〈0.05）.In group A,before the treatment the AFP was（943.1±411ng/mL）,and only 6 patients had AFP reviewed（942.8±468.5 ng/mL）.In group B,the median of AFP before and after the treatment were 621.8 ng/mL and 16.2ng/ml,respectively（P〈0.05）.After treatment,MRI and CT findings demonstrated coagulation necrosis and blood supply reduction or disappearance of tumor in the target region.The CR-,PR-,NC-,and rate of efficacy differed significantly between group A and group B（11.4%,65.7%,22.9%,respectively,vs 28.9%,62.2%,8.9%,respectively,P〈0.05）.Conclusion The patients received TACE prior to HIFU would have better efficacy than those who underwent TACE alone.The clinical efficacy,liver enzymes,AFP got improved to some extent,MRI and CT findings showed coagulation necrosis and blood supply reduction or disappearance of the tumor in the target region.