肝动脉化疗栓塞联合射频消融治疗大肝癌的临床观察

TACE combined with RFA for the treatment of massive primary hepatocellular carcinomas:observation of clinical efficacy and safety

目的 探讨肝动脉化疗栓塞（TACE）联合射频消融（RFA）治疗大肝癌的疗效及安全性。方法 分析2011年3月—2014年6月23例大肝癌患者先行TACE治疗1～2次,再序贯RFA治疗,并随访其术后临床症状、甲胎蛋白（AFP）、肝功能及影像学改变情况等。结果 23例患者治疗后临床症状均有缓解,一般状况改善;所有患者AFP均明显下降,差异有统计学意义（t=2.48,P=0.002）;影像检查见病灶体积有所缩小,病灶内有不同程度的碘油沉积,并可见片状坏死区,增强后无明显强化;显效、有效、无效率分别为43.5%、52.2%、4.3%。随访4～22个月,中位生存时间为9.6个月,半年和1年的生存率分别为86.9%和43.4%。结论 TACE联合RFA治疗大肝癌疗效确切,值得临床推广应用。

Objective To evaluate the clinical efficacy and safety of transarterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） in treating massive hepatocellular carcinomas. Methods A total of 23 patients with massive hepatoeellular carcinoma, who were admitted to authors＇ hospital during the period from March 2011 to June 2014, were enrolled in this study. In all patients TACE of one to two times was performed, which was followed by sequential RFA. All the patients were followed up, and the clinical symptoms, serum AFP levels, hepatic functions and the imaging findings were recorded. Results After the treatment, the clinical symptoms were relieved in all 23 patients. AFP levels in all patients were decreased obviously, and the difference was statistically significant when compared with the preoperative data （t=2.48 ,P=O.002）. Imaging examination showed that the volume of lesion was reduced, and different degrees of iodine oil deposition within the lesions could be observed; there were also patch necrosis areas in the tumor, which showed no obvious enhancement after contrast injection. According to necrosis extent, the markedly effective rate, effective rate and invalid rate of the treatment were 43.5%, 52.2% and 4.3% respectively. All the patients were followed up for 4-22 months; the median survival period was 9.6 months, and the half-year and one-year survival rates were 86.9% and 43.4% respectively. Conclusion For the treatment of massive hepatocellular carcinomas, TACE combined with RFA is very effective and reliable ; therefore, this technique is worthy of clinical application.