腹腔镜微波消融术联合三维适形放疗治疗肝癌转移患者的临床疗效观察

Clinical observation of laparoscopic microwave ablation combined with three-dimensional conformal radiotherapy for patients with liver cancer metastasis

目的探讨腹腔镜微波消融术联合三维适形放疗治疗肝癌转移患者的临床疗效。方法选择肝癌转移患者89例的资料进行回顾性分析,按照患者的治疗方法分为对照组(n=45)和观察组(n=44),对照组患者给予三维适形放疗,观察组患者在对照组基础上使用腹腔镜微波消融术,对比两组的近期治疗效果、治疗前后的生活质量、治疗过程中的各项不良反应以及总生存时间。结果观察组患者的治疗效果、治疗有效率和疾病控制率均优于对照组,差异有统计学意义(P<0.05)。经过治疗后,两组患者的生活质量均提升,观察组的升高幅度大于对照组(P<0.05)。两组患者的发热[37.78%(17/45)vs. 45.45%(20/44)]、疼痛[51.11%(23/45)vs. 61.36%(27/44)]、白细胞下降[40.00%(18/45)vs. 34.09%(15/44)]、肝功能损伤[22.22%(10/45)vs. 15.91%(7/44)]、消化道症状[60.00%(27/45)vs. 70.45%(31/44)]、肾功能损伤[8.89%(4/45)vs. 13.64%(6/44)]发生率差异均无统计学意义(P>0.05)。对照组患者的总生存时间中位数为23.988个月,观察组患者的总生存时间中位数为27.976个月,两组差异有统计学意义(χ~2=4.177,P<0.05)。结论使用腹腔镜微波消融术联合三维适形放疗治疗肝癌转移患者,可以提升治疗效果,改善生活质量,延长患者的生存时间,安全性良好,值得临床推荐。

Objective To evaluate the clinical application of laparoscopic microwave ablation combined with three-dimensional conformal radiotherapy for patients with liver cancer metastasis. Methods A retrospective analysis of 89 patients with liver cancer metastasis, who were treated in our hospital from January 2015 to January 2016, was performed. According to the treatment, the patients were divided into the control group(n=45) and the observation group(n=44). Patients in the control group were given with three-dimensional conformal radiotherapy, and patients in the observation group were treated with laparoscopic microwave ablation on the basis of the control group. The short-term treatment effects of the two groups, the quality of life before and after treatment, the adverse reactions in the two groups, and the total survival time of the two groups were compared. Results The therapeutic effect, treatment efficiency and disease control rate of the observation group were significantly better than the control group(Z=-2.944,χ~2=4.107, 4.302, P<0.05). After treatment, the quality of life of both groups increased, which was significantly greater in the observation group(t=-4.127,-3.318,-3.783,-2.698, P<0.05). There was no significant difference in fever(37.78% vs. 45.45%), pain(51.11% vs. 61.36%), leukopenia(40.00% vs. 34.09%), liver function damage(22.22% vs. 15.91%), gastrointestinal symptoms(60.00% vs. 70.45%), or renal impairment(8.89% vs. 13.64%) between the 2 groups(P>0.05). The median overall survival time of the control group was 23.988 months, which was significantly longer of the observation group(27.976 months,χ~2=4.177, P<0.05). Conclusion Laparoscopic microwave ablation combined with three-dimensional conformal radiotherapy for patients with liver cancer metastasis can improve the treatment efficacy, improve the quality of life, prolong the survival time of patients, with good safety.