人工液胸或气胸辅助氩氦刀治疗膈顶部肝癌

Cryoablation therapy with the aid of artificial hydrothorax or pneumothorax to treat hepatocellular carcinoma adjacent to the diaphragm

目的探讨人工液胸或气胸技术辅助氖氦刀冷冻消融治疗膈顶部肝癌的临床疗效及分析。方法 73例无手术指征膈顶部肝癌患者接受了经肝动脉栓塞化疗(Transcatheter arterial chemoembolization,TACE)联合氩氦刀冷冻消融(argon-helium cryosurgery system,AHCS)治疗。其中,A组38例患者共46个病灶在彩超引导下采用人工液胸或气胸技术辅助进行,B组35例患者共43个病灶无人工液胸或气胸技术辅助,治疗结束后评价近期疗效,并随访生存情况。结果治疗后两组患者外周血AFP值均较术前出现明显下降(P<0.01),术后A组外周血AFP值远低于B组(P<0.05)。术后A组肿瘤完全坏死率远远高于B组,而不完全坏死率,部分坏死率却低于B组,差异有显著性(P<0.05)。两个月后根据新修订的实体瘤疗效评价标准(the modified response evaluation criteria in solid tumors,mRECIST)评价疗效,显示术后A组完全缓解(CR)及稳定(SD)患者数均大于B组(P<0.05),而进展(PD)患者数却远远小于B组(P<0.01)。术后A组并发症发生率远远低于B组。结论彩超引导下人工液胸或气胸技术辅助AHCS联合TACE治疗能充分显示膈顶部肝癌,创伤小、恢复快、并发症少、疗效可靠。

【Objective】To explore the clinical curative of argon-helium cryosurgery system for liver cancer located under the diaphragm with the aid of artificial hydrothorax or pneumothorax.【Methods】73 cases without operation indication of diaphragm hepatocellular carcinoma were treated with transcatheter arterial chemoembolization and argon-helium cryosurgery system. A group of 38 patients with 46 lesions in ultrasound guided by assisted artificial hydrothorax or pneumothorax, B group of 35 patients with 43 lesions without artificial hydrothorax or pneumothorax technical assistance, the recent curative effect was evaluated after the treatment, and were followed for survival. 【Results】The peripheral blood AFP values were significant less than those of preoperative after treatment In the two groups（P〈0.01）, the peripheral blood AFP value of A group was much lower than that of B group after operation（P〈0.05）. The tumor necrosis rate of A group was much higher than that of B group, but not the complete necrosis rate, partial necrosis rate was lower than that in B group postoperatively, there was a significant difference（P〈0.05）. The therapeutic evaluation was taken according to the modified response evaluation criteria in solid tumors（mRECIST） after two months. The number of complete remission（CR） patients and stable disease＇（SD） of A group were higher than those of B group, but the number of partial response（PR） patients was far less than B group postoperatively. The complication rate of a group was much lower than that of B group.【Conclusions】Liver cancer located under the diaphragm can be fully displayed in the treatment of AHCS combined with TACE with the aid of artificial hydrothorax or pneumothorax guided by ultrasound. The treatment has small trauma, rapid recovery and fewer complications. The curative effect is reliable.