经导管肝动脉化疗栓塞联合微波消融治疗大肝癌的近期疗效与安全性分析

Short-term efficacy and safety evaluation of transcatheter arterial chemoembolization in combination with microwave ablation for large hepatic cancer

目的评价经导管肝动脉化疗栓塞术联合微波消融术治疗大肝癌的近期临床疗效与安全性。方法收集我院2013年1月~2014年11月大肝癌患者68例,分为联合组(36例)和对照组(32例),其中AFP阳性患者分别为31例(86.1%)和26例(81.3%)。联合组经TACE联合MWA治疗,对照组仅行TACE治疗。对其临床疗效及并发症发生情况进行分析。结果两组患者在年龄、性别、Child-Pugh分级、病灶数目、最大长径、AFP阳性率方面不存在明显差异。联合组及对照组分别平均治疗(3.6±1.2)次、(4.9±1.8)次,两组差异具有统计学意义(P<0.05),无失访病例。联合组CR 20例(55.6%)、PR 10例(27.8%)、SD 2例(5.6%)、PD 4例(11.1%)、RR 30例(83.4%),对照组CR 8例(25%)、PR 8例(25%)、SD 4例(12.5%)、PD 12例(37.5%)、RR 16例(50%),联合组疾病控制率(RR)及术后AFP转阴率均明显优于对照组(P<0.05)。两组中位生存期分别为19个月和12个月,联合组在12、18、24月的生存率优于对照组(P<0.05)。两组严重并发症的发生率比较无明显差异(P>0.05),且均未出现术中死亡病例。结论 TACE联合MWA治疗大肝癌手术次数少,创伤小,近期疗效确切,安全性高,是大肝癌的有效治疗模式,具有临床推广价值。

Objective To evaluate the short-term efficacy and safety of transcatheter arterial chemoembolization in combination with microwave ablation for large-sized hepatic cancer. Methods A total of 68 cases were collected in affiliated hospital of qingd- ao university from January 2013 to November 2014 and divided into combined group （36 cases） and control group （32 cases）. AFP-positive patients were 31 cases （86.1% ） and 26 cases （81.3 % ）, respectively. The clinical efficacy and adverse reactions were analyzed. Results No significant differences existed between both groups concerning age, sex ratio, Child-Pugh grade, number of lesions, maximum length and positive rate of AFP. Combination group and control group were treated with average of 3.2 ± 1.2 and （4.9 ± 1.8 ） times, respectively, and significant differences existed （ P 〈 0.05 ）. There were 20 CR cases （55.6%）, 10 PR cases （27.8%）, 2 SD cases （5.6%）, 4 PD cases （11.1%） and 30 RR cases （83.4%） in combined group, while 8 CR cases （25%）, 8 PR cases （25%）, 4 SD cases （12.5%）, 12 PD cases （37.5%） and 16 RR cases （50%） in control group. Both the disease control rate （RR） and postoperative AFP negative rate in combination group were significantly better than that in control group （ P 〈 0.05）. Median survival time for both groups was 19 months and 12 months respectively, and the survival rate at 12, 18 and 24 months for combination group was better than that of the control group （ P 〈 0.05）. The incidence of severe complications in both groups had no significant differences （ P 〉 O. 05 ）, and there were no intraoperative deaths. Conclusion Transcatheter arterial chemoembolization in combination with microwave ablation is an effective therapeutic strategy for the treatment of large-sized hepatic cancer with reduced operation frequencies, less trauma, definite short-term efficacy and high safety, herein it would be great valuable for the clinical promotion.