肝动脉化疗栓塞同步联合多源微波消融治疗大肝癌的初步临床应用

Initial Clinical Application of Transcatheter Arterial Chemoembolization Synchronously Combined with Multiple Microwave Ablation in the Treatment of Large Hepatocellular Carcinoma

目的:评价肝动脉化疗栓塞同步联合多源微波消融治疗大肝癌的安全性及疗效。方法:回顾性分析我院2015年7月至2016年6月收治的22例大肝癌患者,肿瘤平均最大径为9.33±3.23cm。所有患者采用肝动脉化疗栓塞同步联合多源微波消融治疗。治疗前后行肝肾功能检查,治疗后1个月行增强MRI检查,采用mRECIST标准对疗效进行评估。计量资料采用t检验分析,采用Kaplan-Meier法计算无进展生存时间(PFS)和总生存时间(OS)。结果:所有患者均成功完成同步联合治疗。治疗后3天内谷丙转氨酶(ALT)、谷草转氨酶(AST)和总胆红素(TBi L)出现一过性升高,白蛋白(ALB)、肌酐(CRE)和凝血酶原时间(PT)等指标在治疗前后无统计学差异(P>0.05)。患者术后出现疼痛15例(68.2%);发热1例(4.5%);右侧胸腔积液6例(27.3%);肝包膜下出血1例(4.5%)。治疗后1个月影像学评价为CR者8例(36.4%),PR者14例(63.6%)。平均随访时间11.42±3.81个月,1年PFS率为32.3%,1年OS率为74.4%。结论:肝动脉化疗栓塞同步联合多源微波消融治疗大肝癌安全有效。

Objective： To evaluate the safety and efficacy of transcatheter arterial chemoembolization （TACE） synchronously combined with multiple microwave ablation in the treatment of large hepatocellular carcinoma （HCC）. Methotis： Twenty-two patients diagnosed as large hepatocellular carcinoma （mean maximum diameter： 9.33 ±3.23cm） in our hospital between July 2015 and June 2016 were analyzed retrospectively. The procedures of TACE synchronously combined with multiple microwave ablation were carried out in all patients. Liver and renal function were examined before and after the treatment. The therapeutic effects were evaluated according to the mRECIST by 1-month follow-up magnetic resonance imaging （MRI）. The t-test was used to compare quantitative variables. Progression-free survival （RFS） and overall survival （OS） rates were calculated by the Kaplan-Meier method. Results： Combined treatment was successfully achieved for all patients. The transient elevation of ALT, AST and TBil occurred within 3 days after the treatment. The level of ALB,CRE, and PT was not statistically significant different before and after the treatment （ P 〉 0. 05 ）. Patients had complications after the treatment as pain in 15, fever in 1, pleural effusion in 6 and liver subcapsular hemorrhage in 1. MRI showed 8 cases with complete response and 14 cases with partial response 1 month after treatment. During the follow-up period （mean, 11.42 ± 3.81 months）, the 1- and 3-year PFS and OS rates were 32.3% and 74.4% , respectively. Conclusion： Transeatheter arterial chemoembolization synchronously combined with multiple microwave ablation is a safe and effective treatment for large hepatocellular carcinoma.