经肝动脉化疗栓塞联合射频消融治疗巨大肝癌的临床研究

Clinical research of trans-arterial chemo-embolization in combination with radio-frequency ablation for the treatment of massive primary hepatocellular carcinoma

目的:探讨肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗巨大肝癌的临床疗效,为临床提供理论依据。方法:选取在医院接受治疗的60例巨大肝癌患者,按治疗方法不同将其分为对照组和观察组,每组30例。对照组行TACE治疗,观察组行TACE联合RFA治疗,两组患者均结合护肝支持治疗。术后通过增强CT评价两组患者的肿瘤坏死情况,记录两组患者的并发症情况及生存时间,监测两组患者的血常规、肝肾功能及免疫功能等指标的变化,比较两种治疗方法的疗效和安全性。结果:治疗后观察组患者0.5年、1年、2年以及3年的生存率均高于对照组患者,两组比较差异有统计学意义(x^2=5.787,x^2=6.814,x^2=4.802,x^2=4.622;P<0.05)。治疗后观察组患者的总胆红素(TBIL)、丙氨酸转氨酶(ALT)及甲胎蛋白(AFP)较对照组患者低,两组比较差异有统计学意义(t=5.775,t=3.332,t=0.231;P<0.05);观察组患者血清T淋巴细胞CD3+、CD4+/CD8+、自然杀伤(NK)细胞、肿瘤坏死因子α(TNF-α)较对照组患者高,两组比较差异有统计学意义(t=6.434,t=5.125,t=6.017,t=4.669;P<0.05)。结论:TACE联合RFA治疗巨大肝癌的临床疗效较单一经肝动脉栓塞化疗显著,值得临床应用。

Objective:To investigate clinical curative effect of trans-arterial chemo-embolization(TACE)in combination with radio-frequency ablation(RFA)for the treatment of massive primary hepatocellular carcinoma so as to provide theoretical basis for clinical practice.Methods:60patients with massive primary hepatocellular carcinoma were divided into control group(30cases)and observation group(30cases)according to the different treatment methods.The patients of control group received the treatment of TACE while the patients of observation group received the combined treatment of TACE and RFA,at the same time,all of the patients of two groups received the supportive treatment for protecting liver.After the operation,the necrosis situations of patients in the two groups were evaluated by using enhanced CT,and their complication and survival time were recorded.Besides,the changes of series of indexes including blood routine,hepatic and renal function and immunologic function were monitored.Based above data,the curative effect and safety of the two therapeutic methods were compared and analyzed.Results:After treatment,the6months,1year,2years,3years survival rate of observation group were significantly higher than that of control group(x2=5.787,x2=6.814,x2=4.802,x2=4.622,P<0.05).And the TBIL,ALT and AFP of observation group were significantly lower than that of control group(t=5.775,t=3.332,t=10.231,P<0.05).Besides,the CD3+,CD4+/CD8+,NK cells and TNF-αof observation group were significantly higher than that of control group(t=6.434,t=5.125,t=6.017,t=4.669,P<0.05).Conclusion:The curative effect of TACE combined with RFA is significantly better than that of single TACE,and it is worthy in clinical popularization and application.