腹腔镜微波消融术联合肝动脉化疗栓塞治疗中晚期肝癌的疗效分析

Transarterial chemoembolization combined with laparoscopic microwave ablation for advanced hepatocellular carcinoma

目的探讨腹腔镜微波消融术联合肝动脉化疗栓塞(TACE)治疗中晚期肝癌的临床应用。方法回顾性分析温州市人民医院2014年1月至2018年12月收治的中晚期肝癌患者90例,分为腹腔镜微波消融术联合TACE组(研究组,46例)和单纯TACE组(对照组,44例),比较两组的疗效及不良反应。结果与对照组比,研究组的客观有效率(37.0%vs 13.6%,P<0.05)和疾病控制率(80.4%vs 61.4%,P<0.05),首次治疗效果有优势。研究组1年生存率(69.6%vs 43.5%,P=0.012)和2年生存率(39.1%vs 27.8%,P=0.027),研究组的治疗效果优于对照组。AFP≥400 ng/L、PIVKA-II≥40μg/L、肿瘤多发、治疗方案、首次治疗效果是影响预后的独立危险因素。两组病例首次治疗后,均未发生严重不良反应及围术期死亡。结论腹腔镜微波消融术联合TACE治疗中晚期肝癌近期疗效好,生存期延长,严重不良反应发生率低,是一种安全、有效的治疗方案。

Objective To evaluate the efficacy and safety of transarterial chemoembolization(TACE)combined with Laparoscopic microwave ablation(LMWA)in patients with advanced hepatocellular carcinoma.Methods A total of 90 patients with advanced hepatocellular carcinoma admitted to Wenzhou People’Hospital from Jan.2014 to Dec.2018 were enrolled in this study and the clinical data were analyzed retrospectively.The patients were divided into study group(46 patients who underwent TACE combined with LWMA)and control group(44 patients who underwent TACE)according to treatment method.The treatment efficacy and adverse reactions of the two groups were compared.Results There was no statistical difference in general information between two groups.The effective rates of the study group and control group were 37.0%and 13.6%,the diease control rates were 80.4%and 61.4%.The 1-year survival rate was 69.6%and 43.5%(P=0.012),and the 2-year survival rate was 39.1%and 27.8%(P=0.027).Treatment effect in the study group was better than that in control group.AEP≥400 ng/L,PIVKA-II≥40μg/L,multiple tumors,choice of treatment plan and first treatment effect were independent risk factors affecting prognosis.No serious adverse reaction or perioperative death occurred in both groups after the first treatment.Conclusion In comparison with TACE alone,TACE combined with LWMA has good short-term curative effect,with prolonged survival period and low incidence of serious adeverse reactions,which is an effective and safe treatment plan.