超选择性肝肿瘤动脉化疗栓塞术联合热疗治疗原发性肝癌临床观察

Therapeutic Effects of S-TACE Combining with High-Frequency Thermotherapy in Primary Hepatocellular Carcinoma

目的分析超选择性肝肿瘤供血动脉化疗栓塞术(S-TACE)联合肝区局部高频深部热疗治疗原发性肝癌(HCC)的疗效。方法选取延边大学附属医院2012年1月至2014年2月收治的50例病灶>5 cm的原发性HCC患者,分成对照组(A组)和治疗组(B组),每组各25例,A组采用单纯S-TACE治疗,B组采用S-TACE联合肝区高频深部热疗治疗。检测术前和术后不同时间段肝功能、s IL-2R、VEGF、IL-6、COX-2,记录术后不良反应(发热、恶心、呕吐、腹胀、疼痛等)以及KPS评分,并随访生存期。结果与治疗前比较,肝功能指标AST、ALT、TBIL和DBIL在A组患者治疗后第1周明显升高(P<0.05),B组治疗后第1周虽有升高,但差异无统计学意义(P>0.05);两组术后第4周KPS评分升高,但仅B组有统计学差异(P<0.05);两组治疗后第1周和第4周血清VEGF及SIL-2R的含量均下降(P<0.05);两组IL-6水平在治疗后第1周和第4周下降(P<0.05);A组术后第4周COX-2表达增强(P<0.05),B组术后第4周后弱表达,甚至比治疗前更低,无统计学差异(P>0.05)。与治疗后第1周比较,两组治疗后第4周IL-6水平均下降(P<0.05),治疗后第4周A组血清VEGF和s IL-2R含量升高(P<0.05),而B组中两者术后第4周下降(P<0.05)。与A组比较,B组术后副反应发生率低(P<0.05)。B组的2年生存率较A组高,有统计学差异(P<0.05)。结论 S-TACE联合热疗可提高HCC患者KPS评分,降低不良反应,改善生存质量和延长生存期。血清SIL-2R、VEGF、IL-6及组织中COX-2变化可能与HCC患者的治疗效果相关。

Objective To analyze the therapeutic effects of S-TACE combining with high-frequency thermotherapy in patients with primary hepatocellular carcinoma（ HCC）. Methods 50 HCC patients were selected from January 2012 to February 2014,and were divided into 2 groups,group A underwent S-TACE alone,group B underwent S-TACE combined with regional high-frequency hyperthermia. The changes of liver function,s IL-2R,VEGF,IL-6,COX-2 contents were determined in patients with HCC pre-and post-treatment. The score of KPS,survival time and side effects（ such as fever,nausea,vomiting,abdominal distension,pain） were analyzed. Results Compared with the pre-treatment,ALT,AST,TBIL and DBIL of the liver significantly increased post-treatment for a week in group A（ P〈0. 05）,but no significant differences in group B. The scores of KPS were improved after 4 weeks treatment in both groups,but only in group B were there significance differences（ P〈0. 05）. Compared with the pre-treatment,the VEGF,IL-2R and IL-6 contents were significantly decreased after the 1st and 4th weeks treatment in the two groups（ P〈0. 05）,the expression of COX-2 was increased in group A（ P〈0. 05）,but there was no change in group B. Compared with the 1st week post-treatment,the IL-6 significantly declined after the 4th week in the two groups. The VEGF and sIL-2R were significantly increased in group A（ P〈0. 05）,while they dramatically decreased in group B after 4th week treatment（ P〈0. 05）. The incidence rate of side effects in group B was significantly lower than that in group A（ P〈0. 05）. 2 year survival rate was significantly lower in group A than in group B（ P〈0. 05）. Conclusion S-TACE combined with regional high-frequency thermotherapy can increase the KPS,improve the quality of life,reduce side effects and prolong survival rate. The contents of serum VEGF,s IL-2R and IL6 and tissue COX-2 may be related to the effects of the S-TACE and regional high-frequency thermotherapy.