超声引导下经皮微波消融联合肝动脉化疗栓塞治疗原发性肝癌的疗效观察

Ultrasound-guided percutaneous microwave ablation combined with transarterial arterial chemoembolization for primary hepatocellular carcinoma

目的探讨原发性肝癌患者行超声引导下经皮微波消融(percutaneous microwave ablation,PMWA)联合肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)治疗的效果及安全性。方法101例原发性肝癌患者随机分为观察组52例和对照组49例。对照组给予TACE治疗,观察组给予TACE联合PMWA治疗。记录2组TACE治疗情况;分别于治疗前及末次TACE治疗后3周检测2组血清鳞状细胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)、糖链抗原(carbohydrate antigen,CA)50、CA19-9、CA724水平;记录2组治疗期间并发症发生情况;末次TACE治疗后1个月评定2组治疗效果;随访观察2组远期生存情况。结果观察组TACE治疗次数[(2.56±0.31)次]较对照组[(3.98±0.42)次]少(P<0.05)。末次TACE治疗后1个月总有效率(84.62%)较对照组(67.35%)高(P<0.05)。观察组、对照组治疗后血清SCC-Ag[(3.65±0.47)、(5.52±0.71)μg/L]、CA50[(40.19±5.22)、(51.37±5.34)ku/L]、CA19-9[(50.30±6.31)、(61.20±7.75)ku/L]、CA724[(15.33±2.10)、(20.89±3.62)ku/L]水平均低于治疗前[SCC-Ag:(7.19±0.93)、(7.20±0.95)μg/L;CA50:(68.59±8.31)、(70.08±8.61)ku/L;CA19-9:(72.25±8.90)、(73.02±9.12)ku/L;CA724:(23.56±3.04)、(24.09±2.97)ku/L](P<0.05);观察组治疗后血清SCC-Ag、CA50、CA19-9、CA724水平低于对照组(P<0.05)。2组治疗期间均未发生气胸、肠瘘、肝包膜下出血、胆漏等严重并发症,观察组并发症发生率(17.31%)与对照组(14.29%)比较差异无统计学意义(P>0.05)。观察组24个月生存率(57.14%)高于对照组(36.17%)(P<0.05)。结论TACE联合PMWA治疗原发性肝癌可降低血清SCC-Ag、CA50、CA19-9、CA724水平,提高疗效,延长生存期,并发症发生率低。

Objective To investigate the efficacy of ultrasound-guided percutaneous microwave ablation combined with transcatheter arterial chemoembolization(TACE)on primary hepatocellular carcinoma and its safety.Methods A total of 101patients with primary hepatocellular carcinoma were randomly divided into 52patients treated with TACE and percutaneous microwave ablation(observation group)and 49patients treated with TACE(control group).The serum squamous cell carcinoma antigen(SCC-Ag),carbohydrate antigen(CA)50,CA19-9and CA724levels were measured before and 3weeks after the final TACE treatment.The complications and long-term survival were recorded.Results The frequency of TACE treatment was less in observation group(2.56±0.31)than that in control group(3.98±0.42)(P<0.05),and the total effective rate was higher in observation group(84.62%)than that in control group(67.35%)(P<0.05).The serum levels of SCC-Ag((3.65±0.47),(5.52±0.71)μg/L),CA50((40.19±5.22),(51.37±5.34)ku/L),CA19-9((50.30±6.31),(61.20±7.75)ku/L)and CA724((15.33±2.10),(20.89±3.62)ku/L)in observation and control groups were lower after treatment than those before treatment(SCC-Ag:(7.19±0.93),(7.20±0.95)μg/L;CA50:(68.59±8.31),(70.08±8.61)ku/L;CA19-9:(72.25±8.90),(73.02±9.12)ku/L;CA724:(23.56±3.04),(24.09±2.97)ku/L)(P<0.05),and lower in observation group than those in control group after treatment(P<0.05).No severe complications as pneumothorax,intestinal fistula,subcapsular hemorrhage of liver and biliary fistula occurred in two groups.The incidence of complications showed no significant difference between observation group(17.31%)and control group(14.29%)(P>0.05).The 24-month survival rate was higher in observation group(57.14%)than that in control group(36.17%)(P<0.05).Conclusion TACE combined with percutaneous microwave ablation can decrease the serum levels of SCC-Ag,CA50,CA19-9and CA724so as to improve the efficacy,reduce the complication and prolong the survival in patients with primary hepatocellular carcinoma.