超声引导下局部综合介入疗法治疗大肝癌患者的效果

Ultrasound-guided local comprehensive intervention therapy for patients with large liver cancer

目的观察超声引导下局部综合介入疗法治疗大肝癌患者的效果。方法选取2020年10月至2022年3月南阳医学高等专科学校第一附属医院收治的95例大肝癌患者进行前瞻性研究。结合治疗指征,将入组患者分为常规组(45例)和试验组(50例)。常规组男25例,女20例,年龄(60.44±5.23)岁。试验组男30例,女20例,年龄(61.32±5.17)岁。常规组实施肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)治疗,试验组采用局部瘤内注射无水乙醇(percutaneous ethanol injection,PEI)、射频消融(radio frequency ablation,RFA)联合TACE的综合介入疗法治疗。所有患者均随访1年。比较两组近期疗效及远期生存情况。采用χ^(2)检验和t检验。结果试验组客观缓解率(overall response rate,ORR)、疾病控制率(disease control rate,DCR)均高于常规组[80.00%(40/50)64.44%比(29/45)、90.00%(45/50)比77.78%(35/45)],差异均有统计学意义(χ^(2)=6.034、5.525,均P<0.05)。治疗前,两组患者肝功能指标差异均无统计学意义(均P>0.05)。治疗后,试验组丙氨酸氨基转移酶(alanine transaminase,ALT)、天冬氨酸氨基转移酶(glutamic pyruvic transaminase,AST)、血清总胆红素(total bilirubin,TBil)水平均低于常规组[(50.25±10.17)U/L比(56.39±10.47)U/L、(48.24±10.49)U/L比(55.16±10.33)U/L、(18.15±5.41)μmol/L比(15.44±5.28)μmol/L],差异均有统计学意义(t=2.897、3.234、2.469,均P<0.05)。治疗后,试验组不良反应发生率为30.00%(15/50),略高于常规组的28.89%(13/45),差异无统计学意义(χ^(2)=0.030,P>0.05)。试验组随访第3、6、12个月生存率均高于常规组[96.00%(48/50)比84.44%(38/45)、90.00%(45/50)比75.56%(34/45)、86.00%(43/50)比68.89%(31/45)],差异均有统计学意义(χ^(2)=7.573、7.314、8.380,均P<0.05)。试验组随访第3、6、12个月复发率均低于常规组[8.00%(4/50)比20.00%(9/45)、16.00%(8/50)比28.89%(13/45)、20.00%(10/50)比33.33%(15/45)],差异均有统计学意义(χ^(2)=5.980、4.773、4.543,均P<0.05)。结论超声引导下局部综合介入疗法能增强大肝癌患者的治疗效果,可在不明显影响患者肝功能或增加不良反应发生风险的同时,有效提升患者远期生存率、降低复发率。

Objective To observe the effect of ultrasound guided local comprehensive intervention therapy for patients with large liver cancer patients.Methods Ninety-five patients with large liver cancer admitted to First Hospital,Nanyang Medical College from October 2020 to March 2022 were selected for the prospective study.According to the treatment indications,the enrolled patients were divided into a conventional group(45 cases)and an experimental group(50 cases).There were 25 males and 20 females in the conventional group;they were(60.44±5.23)years old.There were 30 males and 20 females in the experimental group;they were(61.32±5.17)years old.The conventional group took transcatheter arterial chemoembolization(TACE),while the experimental group took the comprehensive intervention therapy consisting of percutaneous ethanol injection(PEI),radio frequency ablation(RFA),and TACE.All the patients were followed up for one year.The short-term efficacies and long-term survival of the two groups were compared.χ^(2) and t tests were applied.Results The overall response rate(ORR)and disease control rate(DCR)in the experimental group were higher than those in the conventional group[80.00%(40/50)vs.64.44%(29/45)and 90.00%(45/50)vs.77.78%(35/45)],with statistical differences(χ^(2)=6.034 and 5.525;both P<0.05).Before the treatment,there no statistical differences in the levels of liver function indicators between the two groups(all P>0.05).After the treatment,the levels of alanine transaminase(ALT),glutamic pyruvic transaminase(AST),and total bilirubin(TBil)in the experimental group were lower than those in the conventional group[(50.25±10.17)U/L vs.(56.39±10.47)U/L,(48.24±10.49)U/L vs.(55.16±10.33)U/L,and(15.44±5.28)μmol/L vs.(18.15±5.41)μmol/L],with statistical differences(t=2.897,3.234,and 2.469;all P<0.05).After the treatment,the incidence of adverse reactions in the experimental group was 30.00%(15/50),which was slightly higher than that in the conventional group[28.89%(13/45)],with no statistical difference(χ^(2)=0.030;P>0.05).The survival rates in the third,sixth,and twelfth months of the follow up in the experimental group were higher than those in the conventional group[96.00%(48/50)vs.84.44%(38/45),90.00%(45/50)vs.75.56%(34/45),and 86.00%(43/50)vs.68.89%(31/45)],with statistical differences(χ^(2)=7.573,7.314,and 8.380;all P<0.05).The recurrence rates in the third,sixth,and twelfth months of the follow up in the experimental group were lower than those in the conventional group[8.00%(4/50)vs.20.00%(9/45),16.00%(8/50)vs.28.89%(13/45),and 20.00%(10/50)vs.33.33%(15/45)],with statistical differences(χ^(2)=5.980,4.773,and 4.543;all P<0.05).Conclusion Ultrasound-guided local comprehensive intervention therapy for patients with large liver cancer can enhance the treatment effect,effectively improve their long-term survival rate,and reduce recurrence rate,without significantly affecting their liver function or increasing the risk of adverse reactions.