CT引导微波消融结合载药栓塞微球经肝动脉化疗栓塞治疗原发性肝癌的临床疗效

Clinical efficacy of CT-MWA combined with DEB-TACE in the treatment of patients with primary liver cancer

目的:研究CT引导微波消融(CT-MWA)结合载药栓塞微球经肝动脉化疗栓塞(DEB-TACE)治疗原发性肝癌的临床疗效及影响术后无瘤生存时间的危险因素。方法:选取80例原发性肝癌患者作为研究对象,按照治疗方式不同将患者分为研究组和对照组,每组各40例。对照组采用DEB-TACE治疗;研究组采用CT-MWA结合DEB-TACE治疗,比较两组患者疗效、肝功能指标及不良反应发生情况,并分析其影响因素。结果:治疗后,研究组患者总有效率高于对照组(P<0.05);治疗后两周内,两组谷丙转氨酶(ALT)、天门冬氨基酸转移酶(AST)、总胆红素(TBIL)水平均降低,且研究组低于对照组(P<0.05),血清白蛋白(ALB)水平均升高,且研究组高于对照组(P<0.05);研究组不良反应发生率低于对照组(P<0.05)。单因素分析结果显示,肿瘤多发、肿瘤大小>3 cm及甲胎蛋白>20μg/L的患者平均无瘤生存时间更短(P<0.05);有肝病病史、肿瘤数量多发、肿瘤大小>3 cm及单纯采用DEB-TACE术式的患者平均总生存时间更短(P<0.05);多因素分析结果显示,Child-Pugh分级B级、肿瘤数量多发、肿瘤大小>3 cm及甲胎蛋白>20μg/L、单纯采用DEB-TACE手术方式的患者平均无瘤生存时间更短(P<0.05);有肝病病史、肿瘤数量多发、肿瘤大小>5 cm及单纯采用DEB-TACE手术方式的患者平均总生存时间更短(P<0.05)。结论:CT-MWA结合DEB-TACE治疗原发性肝癌手术效果良好,安全性较高,Child-Pugh分级﹑甲胎蛋白>20 pg/L、肿瘤直径>5 cm及肿瘤多发等均是影响患者生存期的独立危险因素。

Objective:To investigate the clinical efficacy of CT-guided microwave ablation(CT-MWA)combined with drug-loaded microspheres transhepatic arterial chemoembolization(DEB-TACE)in the treatment of primary liver cancer and the risk factors affecting postoperative tumor-free survival.Methods:80 patients with primary liver cancer were selected,and they were divided into study group and control group according to different treatment methods,with 40 cases in each group.The control group was treated with DEB-TACE,while the study group was treated with CT-MWA combined with DEB-TACE.The curative effect,liver function and adverse reactions of the two groups were compared,and their influencing factors were analyzed.Results:After treatment,the total effective rate of the study group was higher than that of the control group(P<0.05).Within 2 weeks after treatment,the indexes of alanine aminotransferase(ALT),aspartate amino acid transferase(AST),and total bilirubin(TBIL)in both groups decreased,and the study group was lower than the control group(P<0.05).The levels of serum albumin(ALB)in both groups increased,and the study group was higher than the control group(P<0.05).The incidence of adverse reactions in the study group was lower than that in the control group(P<0.05).Univariate analysis showed that patients with multiple tumors,tumor size>3 cm and tumor marker alpha-fetoprotein value>20μg/L had shorter mean tumor-free survival time(P<0.05).Patients with a history of liver disease,multiple tumors,tumor size>3 cm and DEB-TACE alone had shorter mean overall survival time(P<0.05).Multivariate analysis showed that patients with Child-Pugh grade B,multiple tumors,tumor size>3 cm,tumor marker alpha-fetoprotein>20μg/L,and DEB-TACE surgery alone had shorter mean survival time without tumor(P<0.05).Patients with a history of liver disease,multiple tumors,tumor size>5 cm,and DEB-TACE surgery alone had shorter mean overall survival time(P<0.05).Conclusion:CT-MWA combined with DEB-TACE is effective and safe in the treatment of primary liver cancer.Child-Pugh classification,alpha-fetoprotein>20 pg/L,tumor diameter>5 cm and multiple tumors are independent risk factors affecting the survival of patients.