氩氦刀冷冻消融术联合TACE治疗肝巨大肿瘤的疗效分析

Analysis of curative effect of argon-helium knife cryoablation combined with TACE in the treatment of patients with giant liver tumors

目的:探讨氩氦刀冷冻消融术联合经导管肝动脉化疗栓塞术(TACE)治疗肝巨大肿瘤患者的临床疗效,并分析病灶的影像学变化。方法:选取2017年1月至2020年12月我院收治的78例肝巨大肿瘤患者,分为TACE组35例(仅接受TACE)和联合组43例(接受TACE+氩氦刀冷冻消融术)。比较两组疗效、肿瘤影像学变化、肿瘤标志物、卡氏功能状态评分(KPS)、不良反应,并进行生存分析。结果:联合组治疗有效率为88.37%高于TACE组的68.57%(x^(2)=4.640,P=0.031)。联合组的肿瘤最大直径小于TACE组(t=3.897,P=0.000)。联合组肿瘤坏死的比例高于TACE组(Z=6.557,P=0.038)。联合组的肿瘤标志物甲胎蛋白(AFP)、癌胚抗原(CEA)、异常凝血酶原(DCP)水平低于TACE组(Z=4.393,P=0.000;Z=2.427,P=0.018;Z=2.343,P=0.022)。两组KPS评分及不良反应比较无差异(P>0.05)。TACE组中位生存时间为21(7.5~36)个月,联合组中位生存时间为28(9.8~36)个月,差异有统计学意义(Log rank=7.778,P=0.005)。结论:氩氦刀冷冻消融术联合TACE治疗肝巨大肿瘤可提高疗效,有效缩小肿瘤体积,延长生存时间,增加临床获益。

Objective:To investigate the clinical effects of argon-helium cryoablation combined with transcatheter arterial chemoembolization(TACE)in the treatment of giant liver tumor,and analyze imaging changes of the lesions.Methods:Seventy-eight patients with giant liver tumors who were treated in the hospital from January 2017 to December 2020 were enrolled in this study.They were divided into TACE group(35 cases,TACE alone)and combined group(43 cases,TACE combined with argon-helium cryoablation).Efficacy,imaging changes,tumor markers,Karnofsky Performance Status(KPS)scores and adverse reactions were compared between the two groups,and survival analysis was performed.Results:The response rate in the combined group was 88.37%,higher than 68.57%in TACE group(x^(2)=4.640,P=0.031).The maximum tumor diameter in the combined group was smaller than that in TACE group(t=3.897,P=0.000).The proportion of tumor necrosis in the combined group was higher than that in TACE group(Z=6.557,P=0.038).The levels of tumor markers alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA)and Des-γ-carboxyl prothrombin(DCP)in the combined group were lower than those in TACE group(Z=4.393,P=0.000;Z=2.427,P=0.018;Z=2.343,P=0.022).No significant differences were found between the two groups in terms of KPS scores and adverse reactions(P>0.05).The median survival time of TACE group and the combined group was 21(7.5-36)months and 28(9.8-36)months,respectively(Log rank=7.778,P=0.005).Conclusion:This study shows that argon-helium cryoablation combined with TACE can improve the efficacy in treatment of giant liver tumors,which can effectively reduce the tumor volume,prolong survival time,and increase clinical benefit.