伽玛刀联合超声刀治疗局部中晚期肝癌临床研究

Gamma knife combined with high-intensity focused ultrasound treatment for local advanced hepatic carcinoma

目的评价伽玛刀联合高强度超声聚焦刀治疗局部中晚期肝癌的有效性和安全性。方法 80例不可切除的局部中晚期肝癌患者,随机分为观察组38例和对照组42例,观察组经伽玛刀治疗后再行高强度超声刀治疗,对照组单独应用伽玛刀治疗,比较2组近期疗效和远期疗效,并采用Kaplan-Meier法进行生存分析,绘制生存曲线图。结果治疗3个月时,观察组完全缓解21例、部分缓解7例、稳定8例、进展2例,对照组部分缓解11例、稳定20例、进展11例,观察组肿瘤治疗总有效率(73.68%)高于对照组(26.19%)(P<0.05);Kaplan-Meier法生存分析结果显示,观察组中位生存时间(33.6个月)长于对照组(18.0个月),1、2、3、5a总生存率(87.0%、50.0%、47.0%、24.0%)高于对照组(50.0%、33.0%、17.0%、5.0%)(P<0.05),2组患者均顺利完成全程治疗,治疗后均无明显皮肤灼伤,观察组无明显腹部压痛、腹肌紧张、发热等腹膜炎体征,未出现呕血、黑便等消化道出血征象。结论伽玛刀联合高强度超声刀治疗局部中晚期肝癌安全、有效。

Objective To evaluate the efficacy and safety of gamma knife(γknife)combined with high-intensity focused ultrasound in the treatment of local advanced hepatic carcinoma.Methods Eighty patients with unresectable local advanced hepatic carcinoma were randomly divided into observation group(n=38)undergoingγknife followed by high-intensity focused ultrasound treatment and control group(n=42)undergoing onlyγknife.The short-and long-term effects were observed in two groups.Kaplan-Meier method was used to draw the survival curves for survival analysis.Results The 3-month total effective rate was significantly higher in observation group(73.68%)than that in control group(26.19%)(P<0.05),and the therapeutic result showed complete remission in 21 patients,partial remission in 7,stable in 8 and progression in 2 in observation group,while partial remission in 11,stable in 20 and progression in 11 in control group.Kaplan-Meier analysis showed a longer median survival time(33.6 months)and higher 1-,2-,3-and5-year overall survival rate(87.0%,50.0%,47.0%,24.0%)in observation group than those in control group(18.0 months,50.0%,33.0%,17.0%,5.0%)(P<0.05).Both two groups successfully completed the whole course of treatment,without obvious skin burns.Observation group was found neither obvious signs of peritonitis as abdominal tenderness,abdominal tension and fever,nor signs of gastrointestinal hemorrhage as hematemesis and black stool.Conclusion The combination ofγknife and high-intensity focused ultrasound is safe and effective in the treatment of local advanced hepatic carcinoma.