动脉化疗栓塞术联合氩氦刀冷冻消融治疗不可切除肝癌临床研究

Clinical Study of Transcatheter Arterial Chemoembolization Combined with Argon Helium Cryoablation in Treatment of Unresectable Hepatocellular Carcinoma

目的 分析动脉化疗栓塞术(TACE)联合氩氦刀冷冻消融治疗不可切除的晚期肝细胞癌(HCC)的临床效果及安全性.方法 选取初次确诊的中晚期HCC患者90例,根据数字表法随机分为实验组(n=45例)及对照组(n=45).对照组采用TACE单独治疗,观察组采用TACE联合氩氦刀冷冻消融治疗.比较两组患者近期及远期疗效,比较两组患者肝功能变化情况,比较两组患者术后并发症发生情况.结果 观察组患者术后1个月治疗总有效率(ORR)高于对照组(80.0%,62.2%,χ^2=4.486,P=0.034),两组患者均随访6~27个月,平均随访时间(18.24±5.67)个月;观察组随访期间患者死亡19例,对照组患者随访期间患者死亡28例;观察组的0.5,1,2a生存率分别为100%,84.4%,57.8%,对照组分别为100%,73.3%,40.0%;观察组的中位生存期为高于对照组(16.4个月,13.5个月,P=0.026);观察组患者ALT,TBIL水平高于对照组(t=4.289,2.924,P=0.000,0.002);观察组患者术后1d的VAS评分高于对照组(t=4.825,P=0.000).结论 TACE联合氩氦刀冷冻消融治疗不可切除HCC效果显著,可提高患者生存期且安全.

Objective To analyze the clinical efficacy and safety of arterial chemoembolization (TACE) combined with argon helium cryoablation in treatment of non resectable advanced liver cancer.Method 90 cases of middle and late HCC patients who were first diagnosed and randomly divided into experimental group ( n =45) and control group ( n =45) according to the digital table method.The control group was treated with TACE alone, while the observation group was treated with TACE combined with cryoablation.The short-term and long-term effects of two groups were compared,and the changes of liver function were compared between two groups.The postoperative complications of two groups were compared. Results The objective response rate of the observation group after one months operation was higher than that of the control group (80%,62.2%,χ^2 =4. 4 86, P =0.034).The two groups were followed up for 6~27 months with an average follow-up time of (18.24±5.67) months.19 cases of death were observed in the observation group during the follow-up period.28 cases of death were observed in the control group during the follow-up period.The half year survival rate,1 year survival rate and2-year survival rate of the observation group were100%,84.4% and 57.8% respectively.The control group was100%,73.3% and 40.0%, respectively.The median survival time of the observation group was higher than that of the control group (16.4 months,13.5 months, P =0.026).The levels of ALT and TBIL in the observation group were higher than those in the control group ( t=4.289,2.924,P =0.000,0.002).The VAS score after1 d operation in the observation group was higher than that in the control group ( t=4.825,P =0.000).Conclusion TACE combined with argon helium cryoablation is effective in the treatment of unresectable liver cancer.It can improve the survival time and safety of patients,and is worthy of clinical promotion.