TACE联合冷冻消融治疗肝癌合并破裂出血的临床分析

Clinical Analysis of TACE Combined with Cryoablation in the Treatment of Hepatocellular Carcinoma with Rupture Hemorrhage

目的:分析TACE联合冷冻消融治疗肝癌合并破裂出血的效果、安全性及预后。方法:回顾性分析2009年1月-2016年12月东莞康华医院收治的103例原发性肝癌破裂出血患者的临床资料,资料完整且符合研究条件的患者共81例,其中TACE联合冷冻消融35例,单纯TACE 46例。分析两组的疗效、影响患者生存期预后的因素、不良反应。结果:(1)近期疗效:研究组首次治疗的客观有效率、疾病控制率均高于对照组,差异均有统计学意义(P<0.05)。(2)远期疗效:中位随访时间为5个月,范围是1~84个月,死亡71例,存活10例。研究组和对照组的中位生存时间分别为12个月和3个月;研究组6、12、24个月的总生存率分别为74.1%、46.2%、26.4%,与对照组的28.9%、14.4%、7.2%比较,差异有统计学意义(P<0.05)。(3)单因素分析显示,ECOG评分、Child-Pugh分级、肿瘤数量、门静脉癌栓、远处转移、甲胎蛋白、治疗方法与预后相关,是肝癌破裂出血患者预后的影响因素(P<0.05)。(4)多因素分析显示,肿瘤非单发、门静脉癌栓、远处转移为影响预后的危险因素,TACE联合冷冻消融为保护因素(P<0.05)。(5)两组首次治疗的不良反应均属于轻度,可控制,无严重不良反应以及围手术期死亡病例发生,且两组的不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:TACE联合冷冻消融治疗肝癌合并破裂出血临床效果显著,生存期长,严重不良反应发生率低,是一种安全、有效的治疗方案。

Objective:To analyze the safety and prognosis of TACE combined with cryoablation in the treatment of hepatocellular carcinoma complicated with rupture and hemorrhage.Method:The clinical data of 103 patients with primary liver cancer rupture and hemorrhage admitted to Dongguan Kanghua Hospital from January 2009 to December 2016 were retrospectively analyzed.A total of 81 patients with complete data and meeting the study conditions were included,including 35 patients with TACE combined with cryoablation and 46 patients with TACE alone.The curative effect,the factors affecting the prognosis of the patients and the adverse reactions of the two groups were analyzed.Result:(1)Short-term efficacy:the objective effective rate and disease control rate of the first treatment in the study group were higher than those in the control group,the differences were statistically significant(P<0.05).(2)Long-term efficacy:the median follow-up time was 5 months,ranging from 1 to 84 months,with 71 deaths and 10 survivors.The median survival time was 12 months in the study group and 3 months in the control group.The overall survival rates at 6,12,and 24 months in the study group were 74.1%,46.2%,and 26.4%,respectively,compared with 28.9%,14.4%,and 7.2%in the control group,the difference was statistically significant(P<0.05).(3)Single factor analysis showed,ECOG score,Child-Pugh grading,tumor number,portal vein thrombus,distant metastasis,alpha-fetoprotein,treatment method were correlated with prognosis,and were the influencing factors for prognosis of patients with ruptured and bleeding liver cancer(P<0.05).(4)Multivariate analysis showed that non-single tumor,portal vein thrombosis and distant metastasis were prognostic risk factors,and TACE combined with cryoablation was protective factor(P<0.05).(5)The adverse reactions of the first treatment in the two groups were mild and controllable,and no serious adverse reactions or deaths occurred during the perioperative period,there were no statistically significant differences in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:TACE combined with cryoablation for the treatment of liver cancer with ruptured bleeding has significant clinical benefits,long survival,and low incidence of serious adverse reactions,it is a safe and effective treatment option.