热消融联合肝动脉栓塞化疗治疗小肝癌

The effect of thermal ablation combined TACE on the prognosis of small liver carcinoma

目的评价单纯热消融和与热消融联合经导管肝动脉栓塞化疗（transcatheteraaefialchemoembolization，TACE）对小肝癌的治疗效果。方法回顾性分析选取采用单纯热消融或热消融联合TACE治疗的小肝癌患者。比较2组患者术后肿瘤局部进展率、肝内远处复发率、无瘤生存率、总生存率、并发症发生率、手术死亡率、平均住院时间和费用。结果单纯消融组（45例）与联合治疗组（25例）术后肿瘤局部进展率比较，差异无统计学意义（X2=0．853，P=0．374）。联合治疗组的肝内远处复发率低于单纯消融组（X2=3．845，P=0．046），无瘤生存率高于单纯消融组（X2=5．020，P=0．030）。2组的总生存率比较，差异无统计学意义（X2=2．316，P=0．154）；联合治疗组骨髓抑制发生率高于单纯消融组（X2=5．642，P=0．042），其余并发症发生率及总体并发症发生率比较，差异无统计学意义（X2=2．016，P=0．183）；联合治疗组的住院时间比单纯消融组长（t=5．921，P=0．003），住院费用高（t=7．738，P〈0．001）。结论热消融联合TACE在近期内可减少小肝癌肝内远处复发的机会，提高无瘤生存率，其发生骨髓抑制的风险高于单纯消融组，但不会增加其他并发症的发生机会。

Objective To analyze the short-term and long-term effectiveness of radiofrequency ablation combined with transcatheter arterial chemoembolization （TACE） for the treatment of hepatocellular carcinoma （HCC）. Methods The clinical data of 70 HCC patients who had received thermal ablation （group A） alone or in combination with TACE （group B） were retrospectively analyzed. Results The rate of intrahepatic distant recurrence in group B （25 cases） was lower than that in group A （45 cases） （X2 = 3. 845, P = 0. 046） and the tumor-free survival rate was higher than group A （ X2 = 5.020, P = 0. 030）. There were no differences in the local tumor progression rate （ X2 = 0. 853, P = 0. 374） and overall survival （X2 = 2. 316, P = 0. 154） between two groups. Incidence of bone marrow suppression in group B was higher than that of group A （X2 = 5. 642, P = 0. 042）. Major complications didn＇t occur in any group （ X2 = 2.016, P = 0. 183 ）. The costs was higher（ t = 7.738, P 〈 0. 001 ） and the hospital stay was longer （ t = 5. 921, P = 0. 003） in group B than group A. Conclusions Compared with ablation alone, combined therapy is able to reduce short- term recurrence, and improve tumor-free survival. Combine therapy is safe and effective method for small liver carcinoma.