肝动脉化疗栓塞联合超声引导射频消融治疗肝转移癌效果观察

Comparative study of transcatheter arterial chemoembolization combined with ultrasound-guidedradiofrequency ablation in the treatment of Liver metastases

目的探讨肝动脉化疗栓塞(TACE)联合超声引导射频消融(RFA)治疗肝转移癌的临床价值。方法将156例肝癌患者分为3组:A组:TACE联合RFA治疗组45例(56个肿瘤),B组:单纯TACE组43例(48个肿瘤),C组:单纯超声引导RFA治疗组48例(52个肿瘤)。A组肝动脉化疗栓塞后1~2周行RFA治疗。3组患者治疗后均在1个月后行增强核磁共振(CEMRI)复查并评估疗效。结果治疗后1~3个月,A,B,C 3组肿瘤无强化率分别为78.57%,52.08%,61.54%,肿瘤部分强化率21.43%,47.92%,38.46%,其中1.5~3.0cm肿瘤A组与B组、C组比较,无强化率分别为86.36%,75.0%,68.42%(P=0.086,P=0.128),差异无统计学意义;~4.0cm肿瘤A组与B组、C组比较,无强化率分别为84.21%,44.44%,50.0%(P=0.034,P=0.059),差异有统计学意义;~6.2cm肿瘤A组与B组、C组比较,无强化率分别为60.0%,35.71%,40.0%(P=0.0254,P=0.0459),差异有统计学意义。6~24个月CEMRI肿瘤局部复发率为15.39%,所有患者治疗后6个月后肿瘤明显缩小。结论TACE联合RFA对肝癌治疗效果明显高于单纯TACE或单纯RFA,能够提高患者生存率。

Objective To investigate the clinical value of transcatheter arterial chemoembolization(TACE)combined with ultrasound-guided radiofrequency ablation(RFA)in the treatment of liver metastases.Methods A total of 136 cases with diagnosis of liver metastases were categorised into:Group A:45 cases(56 tumors)were treated with TACE combined with RFA.Group B:43 cases(48 tumors)in TACE alone group;Group C:48 cases(52 tumors)treated with ultrasound-guided RFA alone.In group A,the RFA was implemented after TACE one to two weeks.All patients of three groups were examined by contrast enhanced MRI(CEMRI)one months later to assess the effect,and additional treatment was implemented when there was residual.Results One to three months after treatment,CEMRI was implemented to assess term efficacy.The rates for no-tumor enhancement in groups A,B and C were 78.57%,52.08%and 61.54%,respectively.The rates for partial tumor enhancement in Groups A,B and C were 21.43%,47.92%and 38.46%respectively.When the tumor size was 1.5 cm to 3.0 cm,the rates for no-tumor enhancement in group A,B and C were 86.36%,75.0%,68.42%(P=0.086,P=0.128),respectively,which was not statistically significant;When the tumor size was 3.1cm to 4.0 cm,the rates for no-tumor enhancement in group A,B and C were 84.21%,44.44%,50.0%(P=0.034,P=0.059),respectively,and the difference was not statistically significant;When the tumor size was 4.1cm to 6.2 cm,the rates for no-tumor enhancement in group A,B and C were 60.0%,35.71%,40.0%(P=0.0254,P=0.0459)respectively,which was statistically significant.CEMRI local recurrence was 15.39%and the tumors of all patients were significantly reduced after six months following the treatment.Conclusion The combination therapy of TACE with RFA is better than TACE or RFA therapy alone.