射频消融联合无水酒精局部注射对原发性肝癌的生命质量及预后的影响

Impact of radiofrequency ablation in combination with local injection of anhydrous alcoholon on the quality of life and prognosis of patients with primary liver cancer

目的分析射频消融联合无水酒精局部注射对原发性肝癌的生命质量及预后的影响。方法纳入该院2011年1月-2014年12月射频消融联合无水酒精局部注射治疗的204例原发性肝癌患者进行分析,采用随机数字表法分为对照组104例,治疗组100例,对照组给予超声引导下经皮无水酒精注射治疗,治疗组给予射频消融联合无水酒精局部注射治疗,治疗观察周期为3个月。观察两组治疗前后的肝功能、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,对照组与治疗组患者丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(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、总胆红素和AFP水平较对照组降低,差异均有统计学意义(P<0.05)。治疗前,对照组与治疗组患者EORTC QLQ-C30总体健康情况、躯体功能、社会功能、恶心和呕吐、疼痛、疲倦、失眠、腹泻和食欲减退评分比较,差异均无统计学意义(P>0.05);治疗后,治疗组患者EORTC QLQ-C30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、腹泻和食欲减退评分较对照组降低,差异均有统计学意义(P<0.05)。随访时间截至2015年6月30日,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酒精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酒精局部注射是一种有效的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、手术方式和肿瘤复发相关。

Objective To analyze the impact of radiofrequency ablation in combination with local injection of anhydrous alcohol on the quality of life and prognosis of patients with primary liver cancer. Methods From January2011 to December 2014, the clinical data of 204 patients with primary liver cancer received radiofrequency ablation in combination with anhydrous alcohol local injection treatment were analyzed. All the patients were divided into control group, 104 cases, and combination treatment group, 100 cases, by using random number table method.Patients in control group were given ultrasound guided percutaneous absolute alcohol injection treatment, and patients in combination treatment group were given radiofrequency ablation combined with local injection of anhydrous alcohol. The treatment observation period was 3 months. Observe patients＇ liver function, AFP（AFP） changes before and after the treatment; uses the European organization for research and treatment of cancer quality of life scale（EORTC QLQ C30） to evaluate the quality of patients life changes; then observe the recurrence rate and survival period, and using Logistic regression analysis of risk factors for prognosis. Results Before the treatment, the patients＇ ALT, AST, total bilirubin, albumin, AFP level comparison between the two groups have no statistically significant difference（P〈0.05）; After treatment, patients in combination group＇s ALT, AST, total bilirubin, AFP level was lower than patients in control group, the difference had statistical significance（P〈0.05）. Before the treatment, patients＇ EORTC QLQ C30 overall health, physical function, social function, nausea and vomiting, pain, fatigue, insomnia, diarrhea, loss of appetite, score comparison between the two groups have no statistically significant difference（P〈0.05）;After treatment, the treatment group patients＇ EORTC QLQ C30 general health, physical function, social function score was higher than control group＇s patients; nausea and vomiting, pain, fatigue, insomnia, diarrhea, loss of appetite, score was decreased in combination group, the difference had statistical significance（P〈0.05）. 190 patients were followed up, the follow-up rate was 93.14%, 108 patients survived, 82 patients died. Multiariable Logistic regression analysis results shown 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 prognosis after treatment of primary liver cancer（P〈0.05）. Conclusions Radiofrequency ablation in combination with local injection of anhydrous alcohol is a kind of effective method of treatment of primary liver cancer and prognosis of primary liver cancer and the position and treatment before the onset of ALT, AFP level, intraoperative blood transfusion, operation method and tumor recurrence.