综合介入治疗联合中药对肝细胞肝癌患者长期生存影响的分析

Analysis on Effect of Comprehensive Interventional Therapy on Long-term Survival of Patients with Hepatocellular Carcinoma

目的:探讨肝细胞肝癌(HCC)患者综合介入治疗联合中药对其长期生存的影响。方法:回顾性分析22例接受介入微创联合中药治疗或介入微创联合手术及中药治疗,或介入微创联合中药并细胞因子诱导杀伤(CIK)治疗的HCC患者,获取患者4年以上生存时间的临床资料和随访资料,分析其介入微创综合治疗情况、患者术后生存情况、治疗前后肿瘤反应性、肝功能情况、肝内复发及远处转移情况。结果:采用介入微创+中药治疗9例,介入微创+中药+手术治疗5例,介入微创+中药+CIK治疗8例。最终患者共接受T ACE等介入微创治疗203次,人均9.23次。其中手术患者(5例)共接受介入微创治疗6 8次,占3 3.5%,人均6.8次;未手术患者直接接受介入微创治疗13 5次,占6 6.5%,人均11.25次。所有患者均存活4年以上,其中现仍存活14例,肝癌Ⅱ期20例(9 0.9%),Ⅲ期2例(9.1%);Ch ild-Pugh分级A级19例(86.4%),B级8例(13.6%);患者5、7、9年累积生存率分别为9 0.2%、7 6.6%和51.0%;中位生存期(9.3 5±0.6 0)年。患者接受介入综合治疗的完全缓解率、部分缓解率均较介入综合治疗前升高(P<0.05)。介入综合治疗后,患者的ALT、T Bil指标较治疗前降低(P<0.05),白蛋白水平较治疗前升高(P<0.05);AFP指数转阴4例,原本AFP阴性的6例患者在后期随访中持续升高。随访期间发生肝内转移10例(占45.5%),肝外转移7例(占27.3%)。结论:介入微创联合中医药等综合治疗方法是提高肝细胞肝癌患者长期生存的的重要手段之一。

Objective： To observe the effect of comprehensive interventional therapy on long-term survival of patients with hepatocellular carcinoma（HCC）. Methods：Conducted retrospective analysis on 22 cases of patients with HCC who received minimally invasive intervention combined with Chinese medicine, or minimally invasive intervention combined with operation and Chinese medicine,or minimally invasive intervention combined with Chinese medicine and cytokine-induced killer（CIK）. Obtained the clinical data and follow-up data of patients who survived for more than 4 years. Analyzed the therapeutic condition, postoperative survival,tumor reactivity before and after treatment,liver function,intrahepatic recurrence and distant metastasis after receiving comprehensive minimally invasive intervention. Results：There were 9 cases with treatment of minimally invasive intervention plus Chinese medicine,5 cases with treatment of minimally invasive intervention plus operation and Chinese medicine,and 8 cases with treatment of minimally invasive intervention plus Chinese medicine and CIK. In total, patients received TACE and other interventional minimally invasive treatment 203 times, 9.23 times per capita. Among them, 5 cases of operation patients received minimally invasive intervention 68 times（33.5%）,6.8 times per capita;patients receiving no operation were treated directly with minimally invasive intervention 135 times（66.5%）,11.25 times per capita. All patients survived for more than 4 years,and 15 of them are still alive. There were 20 cases of liver cancer Ⅱ phase（90.9%） and 2 cases of Ⅲ phase（9.1%）. According to Child-Pugh score,there were 19 cases of A level（86.4%） and 8 cases of B level（13.6%）. The cumulative survival rates of patients were 90.2%,76.6% and 51.0% respectively in the 5 th,7 th and 9 th years. Median survival time was（9.35 ±0.60） year. The complete remission rate and partial remission rate of patients having received comprehensive interventional therapy were increased when compared with those before treatment（P〈0.05）. After receiving comprehensive interventional therapy,levels of ALT and TBil of patients were decreased when compared with those before treatment（P〈0.05）, and levels of albumin were increased when compared with those before treatment（P〈0.05）. There were 4 cases of AFP becoming negative, and levels of AFP negative in 6 original cases of AFP-negative patients were consistently elevated in later follow-ups. During follow-up, there were 10 cases of intrahepatic metastasis（45.5%） and 7 cases of extrahepatic metastasis（27.3%）.C o n c l u s i o n ： Comprehensive therapy like minimally invasive intervention combined with Chinese medicine is the key factor to improve the long-term survival of patients with HCC.