肝动脉化疗栓塞联合微波消融术治疗原发性肝癌合并动静脉瘘的临床疗效

Clinical Efficacy of Hepatic Transcatheter Arterial Chemoembolization Combined with Microwave Ablation in the Treatment of Hepatic Cellular Carcinoma with Arteriovenous Shunt

目的探讨肝动脉化疗栓塞(Transcatheter Arterial Chemoembolization,TACE)联合微波消融术(Microwave Ablation,MWA)治疗原发性肝细胞癌(Hepatic Cellular Carcinoma,HCC)合并动静脉瘘(Arteriovenous Shunt,AVS)的临床疗效。方法对78例HCC合并AVS患者的92个肿瘤,按肿瘤大小配对设计分组,分别采用TACE治疗(对照组)和TACE联合MWA治疗(治疗组),观察两组患者治疗后AVS闭合率、短期临床疗效、患者临床症状改善情况以及患者生存期。结果78例患者均完成治疗和随访,治疗后AVS闭合率对照组为63.0%,治疗组为93.5%,差异有统计学意义(P<0.05)。短期临床疗效对照组总有效率为73.9%,治疗组为91.3%(P<0.05)。78例患者临床症状均得到不同程度改善,对照组与治疗组两组患者治疗后肿瘤体积逐渐缩小,6、12个月的肿瘤体积与治疗前比较,差异均具有统计学意义(P<0.05)。对照组与治疗组患者1、2、3年生存率分别为79.5%、58.9%、25.6%和87.1%、64.1%、48.7%,其中3年生存率两组间比较差异有统计学意义(P<0.05)。结论TACE联合MWA治疗HCC合并AVS,能有效提高AVS的闭合率、肿瘤治疗总有效率以及患者远期生存时间。

Objective To investigate the clinical efficacy of hepatic transcatheter arterial chemoembolization(TACE)combined with microwave ablation(MWA)in the treatment of hepatic cellular carcinoma(HCC)with arteriovenous shunt(AVS).Methods The 78 patients(92 tumors)with HCC and hepatic AVS were divided into treatment group(n=39)and control group(n=39)according to tumor size,and were treated with TACE combined with MWA and only TACE,respectively.AVS closure rate,short-term clinical efficacy,improvement of clinical symptoms and survival were observed after TACE treatment and combination therapy.Results All the 78 patients(92 tumors)were treated and followed up.AVS closure rate was 63%after TACE treatment and 93.5%after combined treatment.In the short-term clinical efficacy,the total effective rate of TACE was 73.9%and the combined treatment was 91.3%,both with statistically significant differences(P<0.05).The clinical symptoms of 78 patients were all improved to varying degrees,and the tumor volume gradually decreased after treatment.The tumor volume at 6 and 12 months was statistically significant compared with that before treatment(P<0.05).Two treatments in 1-year,2-year and 3-year survival rates were 79.5%,58.9%,25.6%and 87.1%,64.1%,48.7%,respectively.And the 3-year survial rate was significantly diffent beetween the two groups(P<0.05).Conclusion TACE combined with MWA in the treatment of primary liver cancer with AVS can effectively improve the closure rate of AVS,the total effective rate of tumor treatment and the quality of life of patients.