超声引导下经皮无水乙醇注射联合射频消融治疗中晚期肝癌的效果

Ultrasound-guided Percutaneous Ethanol Injection Combined with Radiofrequency Ablation for Advanced Hepatocellular Carcinoma

目的观察超声引导下经皮无水乙醇注射(PEI)联合经皮射频消融(PRFA)治疗中晚期肝癌(HCC)的临床有效性和安全性。方法选择2010年1月~2016年12在我院诊断为Ⅲ~Ⅳ期HCC的患者85例,根据数字随机法分为A(28例)、B(29例)、C(28例)三组,A组患者用PEI开始治疗,1~2周后予PRFA治疗;B组患者先行PRFA治疗,1~2周后行PEI治疗;C组患者同时接受PEI和PRFA治疗。随访6个月~3年,比较三组患者生存率、肿瘤消融坏死体积、消融后体积、完全消融率、无水乙醇用量、射频能量及肝功能损害指数(谷丙转氨酶和总胆红素水平)。结果A组患者生存率高于B组和C组,差异有统计学意义(P<0.05);B组肿瘤消融坏死体积大于A组和C组,差异有统计学意义(P<0.05);B组消融后体积小于A组和C组,差异有统计学意义(P<0.05);B组完全消融率为82.76%,高于A组的71.43%和C组的64.29%,差异有统计学意义(P<0.05);三组患者无水乙醇用量、射频能量能比较,差异无统计学意义(P>0.05);三组治疗前后谷丙转氨酶和总胆红素水平比较,差异无统计学意义(P>0.05)。结论PEI和PRFA治疗中晚期肝癌安全且有效的,其中以PEI联合PRFA序贯治疗效果为佳。

Objective To observe the clinical efficacy and safety of ultrasound-guided percutaneous ethanol injection(PEI)combined with percutaneous radiofrequency ablation(PRFA)in the treatment of advanced liver cancer(HCC).Methods 85 patients with stageⅢ~ⅣHCC diagnosed in our hospital from January 2010 to December 2016 were enrolled.According to the numerical randomization method,they were divided into three groups:A(28 cases),B(29 cases)and C(28 cases).Patients in group A were treated with PEI and treated with PRFA 1 to 2 weeks later.Group B patients were treated with PRFA first,and PEI was treated 1 to 2 weeks later.Group C patients were treated with PEI and PRFA.After 6 months to 3 years of follow-up,the survival rate,tumor ablation necrosis volume,ablation volume,complete ablation rate,absolute ethanol dosage,radiofrequency energy and liver function damage index(alanine aminotransferase and total bilirubin levels)were compared between the three groups.Results The survival rate of patients in group A was higher than that in group B and C,the difference was statistically significant(P<0.05).The tumor ablation necrosis volume in group B was greater than that in group A and group C,the difference was statistically significant(P<0.05).The volume of group B after ablation was smaller than group A and group C,the difference was statistically significant(P<0.05);the complete ablation rate of group B was 82.76%,higher than 71.43%in group A and 64.29%in group C,the difference was statistically significant(P<0.05);the amount of absolute ethanol in the three groups,there was no significant difference in radiofrequency energy(P>0.05).There was no significant difference in the levels of alanine aminotransferase and total bilirubin between the three groups before and after treatment(P>0.05).Conclusion PEI and PRFA are safe and effective in the treatment of advanced liver cancer.The sequential treatment with PEI combined with PRFA is better.