TACE序贯联合微波消融术与TACE治疗大肝癌临床疗效及安全性比较

The comparison of clinical efficacy and safety of tace sequential combined microwave ablation with tace in the treatment of large liver cancer

目的对比肝动脉化疗栓塞术(TACE)序贯联合CT引导肝肿瘤微波消融术(MWA)治疗大肝癌与单纯TACE治疗大肝癌的临床疗效与安全性。方法采用回顾性分析,共选取60例于潍坊市中医院肝病科就诊治疗的大肝癌患者,根据其治疗方式不同分为TACE序贯微波消融联合治疗组36例和单纯TACE对照组24例,比较两组治疗后1年、3年、5年生存率、有效率、复发率、AFP下降水平以及副作用、并发症的发生率。结果联合组疾病控制率(88.9%)优于对照组(62.5%),差异有统计学意义(P<0.05);两组患者1年、3年、5年生存率:联合组97.2%,69.4%,25%,对照组83.3%,41.7%,12.5%,中位生存期分别为44个月和28个月,差异有统计学意义(P<0.05);联合组AFP术后1个月水平(102.87±17.95)mg/ml与对照组AFP术后1个月水平(97.71±20.14)mg/ml比较,差异无统计学意义(P>0.05);联合组1年复发2例(5.6%),3年复发9例(25%),5年复发19例(52.8%),对照组1年复发3例(12.5%),3年复发10例(41.7%),5年复发15例(62.5%),差异无统计学意义(P>0.05);两组术后副作用及并发症比较,差异无统计学意义(P>0.05)。结论①两组在疾病控制率、生存率等方面存在差异,TACE序贯微波消融术联合治疗对控制肿瘤发展有更好的疗效;②两组在治疗后AFP下降水平、复发率方面无明显差异,安全性均可。③TACE序贯联合CT引导下微波消融术可作为大肝癌的临床常规治疗手段,但治疗后应注意加强保肝治疗。

Objective To compare the clinical efficacy and safety of sequential transcatheter arterial chemoembolization(TACE)combined with CT guided microwave ablation(MWA)for large hepatocellular carcinoma(HCC)with that of TACE alone.Methods Retrospective analysis was used to select 60 patients with large liver cancer who were treated in the Hepatology Department of Weifang Hospital of Traditional Chinese Medicine.According to the different treatment methods,they were divided into TACE sequential microwave ablation combined treatment group of 36 patients and TACE control group of 24 patients.The survival rate,effective rate,recurrence rate,AFP decline level,side effects and complications of the two groups were compared after one,three and five years of treatment.Results The disease control rate of the combined group(88.9%)was better than that of the control group(62.5%),with a statistically significant difference(P<0.05);The one year,three year and five year survival rates were 97.2%,69.4%and 25%in the combined group and 83.3%,41.7%and 12.5%in the control group.The median survival periods were 44 months in the combined group and 28 months in the control group respectively,with statistically significant differences(P<0.05);There was no significant difference between the level of AFP in the combined group[(102.87±17.95)mg/ml] and that in the control group[(97.71±20.14)mg/ml]one month after operation(P>0.05);In the combined group,two cases recurred in one year(5.6%),nine cases recurred in three years(25%),nineteen cases recurred in five years(52.8%),three cases recurred in one year(12.5%),ten cases recurred in three years(41.7%),and fifteen cases recurred in five years(62.5%),with no significant difference(P>0.05);There was no significant difference in side effects and complications between two groups(P>0.05).Conclusions There are differences in disease control rate and survival rate between the two groups.TACE sequential microwave ablation combined with chemotherapy is more effective in controlling tumor development;②There was no significant difference in AFP decline level and recurrence rate between the two groups after treatment,and both groups were safe.③TACE sequential combined with CT guided microwave ablation for large liver cancer can be used as a routine clinical treatment for large liver cancer,but it should pay attention to strengthening the liver protection treatment aftertreatment.