单独与联合介入治疗肝癌的临床对比分析

Comparative Analysis of the Simple Intervenient and the Combined Intervenient Therapies for the Hepatocellular Carcinoma

目的分析比较射频消融术(RFA)联合肝动脉化疗栓塞术(TACE)与单独TACE治疗肝癌的临床疗效。方法回顾性分析2009年6月~2015年12月因肝癌到北华大学附属医院住院的患者58例,RFA+TACE 25例(为实验组),单独TACE33例(为对照组)。统计学方法对比分析两组治疗前、治疗后1周及1个月的肝功能、中性粒细胞/淋巴细胞比值(NLR)、甲胎蛋白(AFP)、异常凝血酶原(PIVKA-Ⅱ)、CT/MRI,并随访1年。结果 (1)两种治疗方法未明显加重肝脏的损伤;(2)两组NLR较治疗前均降低,实验组较对照组降低更明显,组间比较差异有统计学意义(P<0.05);(3)实验组与对照组PIVKA-Ⅱ较治疗前减低,实验组降低更明显,组间及组内比较差异有统计学意义(P<0.05);(4)AFP较治疗前均降低,差异具有统计学意义(P<0.05),组间比较P=0.512,差异无统计学意义;(5)实验组与对照组有效率分别为88.0%、63.6%,差异有统计学意义(P=0.036);(6)1年生存率分别为76.0%(19/25)、72.7%(24/33),差异无统计学意义(P>0.05)。结论联合治疗并未明显加重肝脏的损伤,能更好地维持促肿瘤炎性状态与抗肿瘤免疫状态的平衡性,比单独治疗肝癌的疗效更好,值得临床推广。

Objective To explore the clinical efficacy of the radiofrequency ablation combined with transcatheter arterial chemoem- bolization and the transcatheter arterial chemoembolization for the hepatoeellular carcinoma. Methods In this retrospective study,58 cases of the hepatoeellular carcinoma patients in Beihua University from June 1,2009 to December 1,2015 were included into survey. 25 pa- tients with the RFA ＋ TACE were selected as experimental group, and 33 cases with the TACE were selected as control group. We detec- ted and analysis the liver function, NRL,AFP,PIVKA - Ⅱ , CT/MRI before and after one week or month of the therapy. All the patients were followed up for 1 year. Results （1） The two methods did not increase the damage of liver. （2） the NLR of the two gropes was de- creased. The experimental group was more obvious and the difference was statistically significant （ P 〈 O. 05 ）, （3） The decline about PIVKA -Ⅱof the experimental group was more obvious than the control group, and the difference was statistically significant（ P 〈 0.05 ）. （4） The AFP levels of the two groups were decreased, and the difference had statistically significant（ P 〈 O. 05） ; but the comparison among the two groups had no statistically significant（ P 〉 0.05 ）. （5）The remission rate of the two groups was 88.0% ,63.6%, and the difference was statistically significant（P 〈 0.05 ）. （6）But the survival rates of the experimental and control groups respectively were 76.0% （19/ 25）. 72.7% （24/33）, and the difference has no statistically significant （ P 〉 O. 05 ）. Conclusion The combined intervenient therapies can keep a better balance between relieving immune suppression and switching the inflammatory state,and will not obviously accentuated the liver damage. The combined treatment can improve therapeutic efficacy, and is worthy of clinical promotion.