高强度聚焦超声联合动脉栓塞化疗治疗晚期肝癌的初步临床研究

High intensity focused ultrasound therapy combined with transcatheter arterial chemoembolization for advanced hepatocellular carcinoma

目的 探讨高强度聚焦超声 (HIFU)联合经动脉栓塞化疗 (TACE)治疗晚期肝癌的有效性。方法 5 0例不能手术切除的晚期肝癌患者 (TNM分期Ⅳ期 )随机分为两组 :(1)单纯TACE组 2 6例 ;(2 )HIFU联合TACE组 2 4例 ,在TACE治疗后 2～ 3周 ,接受HIFU治疗。全部患者随访 3～ 2 4个月 ,平均 (8.16± 2 .79)个月。应用Kaplan Meier等统计学方法分别比较了两组患者的中位生存时间、6个月和 1年生存率、死亡患者平均生存时间。结果 HIFU联合TACE治疗组患者的中位生存时间为11.3个月 ,6个月和 1年生存率分别为 80 .4 %～ 85 .4 %和 4 2 .9% ;而TACE治疗组患者的中位生存时间为 4个月 ,6个月和 1年生存率分别为 13.2 %和 0 % ,两组比较 ,差异有显著性 (P <0 .0 1)。HIFU联合TACE治疗组死亡患者的平均生存时间为 (10 .2 1± 4 .12 )个月 ,而TACE组患者为 (4 .35± 2 .39)个月 ,两组比较 ,差异有显著性 (P <0 .0 1)。结论 HIFU联合TACE治疗晚期肝癌患者的疗效明显优于单纯TACE ,此联合治疗有望成为不能手术切除肝癌的一种有效手段。

Objective To study high intensity focused ultrasound (HIFU) therapy combined with transcatheter arterial chemoembolization (TACE) in the treatment of patients with advanced hepatocellular carcinoma (HCC). Methods Fifty patients with unresectable HCC (TNM stage IV) were randomized into a TACE (T) group and a TACE plus HIFU (T+H) group. Twenty six patients underwent TACE alone, and 24 HIFU ablation 2 3 weeks after TACE. The mean follow up time for all patients was 8.16±2.79 months (range 3 to 24 months). The median survival, 6 month , 1 year survival rates and average survival of patients who died were calculated by Kaplan Meier method and Fisher exact test. Results The median survival time, 6 month and 1 year survival rates were 11.3 months, 80.4 85.4% and 42.9% in T+H group, in contrast to 4 months, 13.2% and 0% in T group with significant differences ( P <0.01). The average survival time of patients who died was 10.21±4.12 months in T+H group, as compared with 4.35±2.39 months in T group also with significant differences ( P <0.01). Conclusion High intensity focused ultrasound therapy (HIFU) combined with transcatheter arterial chemoembolization(TACE), being better than TACE alone, may become one of the most effective treatments for patients with unresectable HCC. [