射频消融联合无水乙醇局部注射对原发性肝癌的生命质量及预后的影响

Radiofrequency ablation in combination with local injection of anhydrous alcohol effects on the quality of life and prognosis in primary liver cancer

目的分析射频消融联合无水乙醇局部注射对原发性肝癌患者生命质量及预后的影响。方法对内蒙古医科大学附属医院2011年1月至2014年12月射频消融联合无水乙醇局部注射治疗的204例原发性肝癌患者临床资料进行分析,采用随机数字表法分为对照组104例和治疗组100例。对照组给予超声引导下经皮无水乙醇注射治疗,治疗组给予射频消融联合无水乙醇局部注射治疗,治疗观察周期均为3个月。观察两组治疗前后患者肝功能、甲胎蛋白(AFP)的变化;使用欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)评价患者生命质量的改变;观察复发率及生存期,采用Logistic回归分析预后的危险因素。结果治疗前,与治疗组患者相比,对照组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素、清蛋白、AFP水平比较,差异均无统计学意义(P>0.05);治疗后,治疗组患者ALT、AST、总胆红素、清蛋白、AFP水平比对照组显著降低,差异均有统计学意义〔ALT(U/L):30.16±18.55比39.56±20.48,AST(U/L):32.25±19.48比40.44±21.56,总胆红素(μmol/L):5.40±2.57比9.54±3.25,清蛋白(g/L):42.54±6.89比40.24±6.87,AFP(μg/L):154±82比223±107,均P<0.05〕。治疗前,对照组与治疗组患者生命质量无显著差异(P>0.05);治疗后,治疗组患者总体健康情况、躯体功能、社会功能评分较对照组升高,恶心和呕吐、疼痛、疲倦、失眠、腹泻、食欲减退评分显著降低,差异均有统计学意义〔健康情况(分):71.63±10.65比65.24±11.21,躯体功能(分):89.04±8.60比85.26±8.53,社会功能(分):72.88±13.22比65.59±13.06,恶心和呕吐(分):16.33±14.33比27.36±19.22,疼痛(分):17.28±11.77比25.32±10.07,疲倦(分):17.67±11.20比28.87±12.05,失眠(分):14.38±14.57比28.50±20.36,腹泻(分):4.98±8.24比15.98±20.05,食欲减退(分):13.55±15.25比29.77±20.21,均P<0.05〕。本研究共随访了190例患者,随访率为93.14%,健在的患者有108例,死亡的患者有82例。多因素Logistic回归分析结果显示,发病位置、治疗前ALT、AFP水平、术中输血、手术方式、肿瘤复发与射频消融联合无水乙醇局部注射治疗原发性肝癌后预后相关(P<0.05)。结论射频消融联合无水乙醇局部注射是一种有效治疗原发性肝癌的方法,原发性肝癌预后与发病位置、治疗前ALT、AFP水平、术中输血、手术方式、肿瘤复发相关。

Objective To analyse radiofrequency ablation in combination with local injection of anhydrous alcohol effects on the quality of life and prognosis in primary liver cancer. Methods Radiofrequency ablation in combination with anhydrous alcohol local injection treatment of 204 patients from January 2011 to December 2014in Inner Mongolia medical University affiliated hospital with primary liver cancer were analyzed, random number table method was used to divide them into control group（104 cases）and the treatment group（100 cases）. Patients in control group underwent ultrasound guided percutaneous absolute alcohol injection, treatment group was given radiofrequency ablation combined therapy with local injection of anhydrous alcohol, observation period lasted for 3 months. The changes of liver function and AFP before and after the treatment of these two groups were measured. The European organization for research and treatment of cancer quality of life scale（EORTC QLQ C30） was used to evaluate the quality of the patients life changes. To observe the recurrence rate and survival period, using the Logistic regression analysis of risk factors was performed for prognosis. Results Before the treatment, alanine aminotransferase（ALT）, aspartate transaminase（AST）, total bilirubin, albumin and alpha fetoprotein（AFP） level in the control group and treatment group had no statistically significant difference（P〉 0.05）; After treatment, compared with control group patients, ALT, AST, total bilirubin, albumin and AFP level in treatment group was significantly lower〔ALT（U/L）：30.16±18.55 vs. 39.56±20.48,AST（U/L）：32.25±19.48 vs. 40.44±21.56,total bilirubin（μmol/L）：5.40±2.57 vs. 9.54±3.25,albumin（g/L）：42.54±6.89 vs. 40.24±6.87,AFP（μg/L）：154±82 vs. 223±107,all P 〈0.05〕. Before treatment, there were no statistically significant difference in control group and treatment group patients＇ quality of life; After treatment, the treatment group patients＇ general health, physical function, social function score were higher than the control group. Compared with control group,nausea and vomiting, pain, fatigue, insomnia, diarrhea, loss of appetite score decreased, the difference had statistical significance 〔general function（score）：71.63±10.65 vs. 65.24±11.21,physical function（score）：89.04±8.60 vs. 85.26±8.53,social function（score）：72.88±13.22 vs. 65.59±13.06,nausea and vomiting（score）：16.33±14.33 vs. 27.36±19.22,pain（score）：17.28±11.77 vs. 25.32±10.07,fatigue（score）：17.67±11.20 vs. 28.87±12.05,insomnia（score）：14.38±14.57 vs. 28.50±20.36,diarrhea（score）：4.98±8.24 vs. 15.98±20.05,loss of appetite（score）：13.55±15.25 vs. 29.77±20.21,all P 〈0.05〕. A total number of 190 patients were followed up and, the follow-up rate was 93.14%, there were 108 surviving patients, 82 patients died. Multivariable Logistic regression analysis showed that the disease position, ALT, AFP level before treatment, intraoperative blood transfusion, operation method, tumor recurrence and radiofrequency ablation combined local injection of anhydrous alcohol associated with prognosis after treatment of primary liver cancer（P 〈0.05）. Conclusion Radiofrequency ablation in combination with local injection of anhydrous alcohol is a kind of effective method of treatment in primary liver cancer. The prognosis of primary liver cancer was associated with the position and ALT, AFP level before treatment, intraoperative blood transfusion, operation method and tumor recurrence.