经皮微波消融结合温度监测及无水乙醇注射治疗近胃肠道肝细胞癌的疗效评估

Curative effect of percutaneous microwave ablation combined with temperature monitoring and ethanol injection on proximal gastrointestinal tract hepatocellular carcinoma

目的：观察经皮微波消融结合温度监测及无水乙醇注射治疗近胃肠道肝细胞癌的临床疗效。方法选取新郑市人民医院收治的近胃肠道肝细胞癌（肿瘤与胃肠道距离≤5 cm）患者68例（88个肿瘤）作为观察组，取同期收治的近胃肠道肝细胞癌患者60例（81个肿瘤）作为对照组，均在温度监测下行经皮微波消融治疗，观察组于近胃肠道边缘肿瘤组织内注射无水乙醇，对照组不予以处理。记录两组治疗前及治疗后1、3个月血清甲胎蛋白（ AFP）水平变化情况；记录肿瘤消融率和并发症发生率；随访12～17个月，了解两组病死率、复发率及肝内转移率。结果观察组肿瘤完全消融率为91.18％，显著高于对照组的64.71％，观察组治疗1、3个月血清甲胎蛋白（ AFP）水平分别为（158.41±18.33）、（57.59±11.26）μg／L，均显著低于对照组，差异有统计学意义（P＜0．05）。随访12～17个月，观察组病死率和肝内转移率分别为17.71％、13.24％，显著低于对照组的30.0％、28.33％，差异有统计学意义（ P＜0.05）。结论温度监测下经皮微波消融联合无水乙醇注射治疗近胃肠道肝细胞癌，有利于提高肿瘤完全消融率。

Objective To observe the clinical efficacy of percutaneous microwave ablation combined with tempera-ture monitoring and ethanol injection on proximal gastrointestinal tract hepatocellular carcinoma.Methods Sixty-eight pa-tients（88 tumors） with proximal gastrointestinal tract hepatocellular carcinoma （cancer and gastrointestinal distance is less than or equal to 5 cm） were selected as the observation group, 60 patients（81 tumors） with proximal gastrointestinal tract hepatocellular carcinoma at the same time were selected as the control group, patients were given percutaneous microwave ablation underwent the temperature monitoring, and patients in observation group were given percutaneous ethanol injection in the tissue near the gastrointestinal edge of intratumoral.The changes of serum alpha fetoprotein （ AFP） level of the two groups were recorded before treatment and 1, 3 months after treatment;and the tumor ablation rate and incidence of compli-cations were recorded.The cases were followed up for 12-17 months, the mortality, recurrence rate and liver metastasis rate of the two groups were recorded.Results In observation group, the complete tumor ablation rate （91.18%） was sig-nificantly higher than that in control group（64.71%） .After 1, 3 months treatment followed up, serum AFP level of obser-vation group was （158.41 ±18.33） g/L, （57.59 ±11.26） g/L respectively, which were significantly lower than those of control group（P〈0.05）.With 12 to 17 months follow up, the mortality and intrahepatic metastasis rates of observation group was 17.71% and 13.24% respectively, which were significantly lower than those of control group （ 30.00%, 28.33%） , the differences were significant （ P 〈0.05 ） .Conclusions Percutaneous microwave ablation combined with ethanol injection and temperature monitoring in the treatment of proximal gastrointestinal tract hepatocellular carcinoma is conducive to improving the rate of complete tumor ablation.