Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice

BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method.Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized.Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from <40 mL (80%) to >80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations.Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Efficacy of radiofrequency ablation combined with sorafenib for treating liver cancer complicated with portal hypertension and prognostic factors

BACKGROUND Patients with liver cancer complicated by portal hypertension present complex challenges in treatment.AIM To evaluate the efficacy of radiofrequency ablation in combination with sorafenib for improving liver function and its impact on the prognosis of patients with this condition.METHODS Data from 100 patients with liver cancer complicated with portal hypertension from May 2014 to March 2019 were analyzed and divided into a study group(n=50)and a control group(n=50)according to the treatment regimen.The research group received radiofrequency ablation(RFA)in combination with sorafenib,and the control group only received RFA.The short-term efficacy of both the research and control groups was observed.Liver function and portal hypertension were compared before and after treatment.Alpha-fetoprotein(AFP),glypican-3(GPC-3),and AFP-L3 levels were compared between the two groups prior to and after treatment.The occurrence of adverse reactions in both groups was observed.The 3-year survival rate was compared between the two groups.Basic data were compared between the survival and non-surviving groups.To identify the independent risk factors for poor prognosis in patients with liver cancer complicated by portal hypertension,multivariate logistic regression analysis was employed.RESULTS When comparing the two groups,the research group's total effective rate(82.00%)was significantly greater than that of the control group(56.00%;P<0.05).Following treatment,alanine aminotransferase and aspartate aminotransferase levels increased,and portal vein pressure decreased in both groups.The degree of improvement for every index was substantially greater in the research group than in the control group(P<0.05).Following treatment,the AFP,GPC-3,and AFP-L3 levels in both groups decreased,with the research group having significantly lower levels than the control group(P<0.05).The incidence of diarrhea,rash,nausea and vomiting,and fatigue in the research group was significantly greater than that in the control group(P<0.05).The 1-,2-,and 3-year survival rates of the research group(94.00%,84.00%,and 72.00%,respectively)were significantly greater than those of the control group(80.00%,64.00%,and 40.00%,respectively;P<0.05).Significant differences were observed between the survival group and the non-surviving group in terms of Child-Pugh grade,history of hepatitis,number of tumors,tumor size,use of sorafenib,stage of liver cancer,histological differentiation,history of splenectomy and other basic data(P<0.05).Logistic regression analysis demonstrated that high Child-Pugh grade,tumor size(6–10 cm),history of hepatitis,no use of sorafenib,liver cancer stage IIIC,and previous splenectomy were independent risk factors for poor prognosis in patients with liver cancer complicated with portal hypertension(P<0.05).CONCLUSION Patients suffering from liver cancer complicated by portal hypertension benefit from the combination of RFA and sorafenib therapy because it effectively restores liver function and increases survival rates.The prognosis of patients suffering from liver cancer complicated by portal hypertension is strongly associated with factors such as high Child-Pugh grade,tumor size(6-10 cm),history of hepatitis,lack of sorafenib use,liver cancer at stage IIIC,and prior splenectomy.

Subpicosecond laser ablation behavior of a magnesium target and crater evolution:Molecular dynamics study and experimental validation

The micro-ablation processes and morphological evolution of ablative craters on single-crystal magnesium under subpicosecond laser irradiation are investigated using molecular dynamics(MD) simulations and experiments.The simulation results exhibit that the main failure mode of single-crystal Mg film irradiated by a low fluence and long pulse width laser is the ejection of surface atoms,which has laser-induced high stress.However,under high fluence and short pulse width laser irradiation,the main damage mechanism is nucleation fracture caused by stress wave reflection and superposition at the bottom of the film.In addition,Mg[0001] has higher pressure sensitivity and is more prone to ablation than Mg[0001].The evolution equation of crater depth is established using multi-pulse laser ablation simulation and verified by experiments.The results show that,under multiple pulsed laser irradiation,not only does the crater depth increase linearly with the pulse number,but also the quadratic term and constant term of the fitted crater profile curve increase linearly.

Percutaneous transhepatic cholangiography:An effective option for endo-biliary radiofrequency ablation before stent insertion in unresectable biliary cancer?

Biliary cancer is a highly aggressive disease that is typically diagnosed at advanced stages when surgical removal is no longer an option.In these cases,palliative care and mechanical widening of the blocked biliary system are preferred.The insertion of a stent is often necessary to prevent the recurrence of blockages caused by cancer progression.Prior to stent placement,endo-biliary radiofrequency ablation(EB-RFA)appears to result in longer-lasting stent effectiveness without increasing the risk of severe complications.However,its impact on overall survival is not yet clear.Additionally,while endoscopic retrograde cholangiopancreatography is the most common method for performing EB-RFA,percutaneous transhepatic cholangiodrainage seems to be a safe and potentially more efficient alternative,particularly for long,angulated,or significantly narrowed bile ducts.

Analysis of alkaline phosphatase and γ-glutamyltransferase after radiofrequency ablation of primary liver cancer: A retrospective study

BACKGROUND Changes in alkaline phosphatase(ALP)andγ-glutamyltransferase(GGT)levels in patients with primary liver cancer(PLC)after radiofrequency ablation(RFA).Hepatocellular carcinoma is a malignant tumor with high incidence worldwide.As a common local treatment,RFA has attracted much attention for its efficacy and influence on liver function.AIM To investigate the effect of serum ALP and GGT levels on the prognosis of patients with PLC treated by RFA.METHODS The preoperative clinical data of 165 patients who were pathologically or clinically diagnosed with PLC and who received RFA in our hospital between October 2018 and June 2023 were collected.The chi-square test was used to compare the data between groups.The Kaplan-Meier method and Cox regression were used to analyze the associ-ations between serum ALP and GGT levels and overall survival,progression-free survival(PFS)and clinical characteristics of patients before treatment.RESULTS The 1-year survival rates of patients with normal(≤135 U/L)and abnormal(>135 U/L)serum ALP before treatment were 91%and 79%,respectively;the 2-year survival rates were 90%and 68%,respectively;and the 5-year survival rates were 35%and 18%,respectively.The difference between the two groups was statistically significant(P=0.01).Before treatment,the 1-year survival rates of patients with normal serum GGT levels(≤45 U/L)and abnormal serum GGT levels(>45 U/L)were 95%and 87%,the 2-year survival rates were 85%and 71%,and the 5-year survival rates were 37%and 21%,respectively.The difference between the two groups was statist-ically significant(P<0.001).Serum ALP[hazard ratio(HR)=1.766,95%confidence interval(95%CI):1.068-2.921,P=0.027]and GGT(HR=2.312,95%CI:1.367-3.912,P=0.002)is closely related to the overall survival of PLC patients after RF ablation and is an independent prognostic factor.The 1-year PFS rates were 72%and 50%,the 2-year PFS rates were 52%and 21%,and the 5-year PFS rates were 14%and 3%,respectively.The difference between the two groups was statistically significant(P<0001).The 1-year PFS rates were 81%and 56%in patients with normal and abnormal serum GGT levels before treatment,respectively;the 2-year PFS rates were 62%and 35%,respectively;and the 5-year PFS rates were 18%and 7%,respectively,with statistical significance between the two groups(P<0.001).The serum ALP concentration(HR=1.653,95%CI:1.001-2.729,P=0.049)and GGT(HR=1.949,95%CI:1.296-2.930,P=0.001)was closely associated with PFS after RFA in patients with PLC.The proportion of male patients with abnormal ALP levels is high,the Child-Pugh grade of liver function is poor,and the incidence of ascites is high.Among GGT-abnormal patients,the Child-Pugh grade of liver function was poor,the tumor stage was late,the proportion of patients with tumors≥5 cm was high,and the incidence of hepatic encephalopathy was high.CONCLUSION Serum ALP and GGT levels before treatment can be used to predict the prognosis of patients with PLC after RFA,and they have certain guiding significance for the long-term survival of patients with PLC after radiofrequency therapy.

Efficacy and safety of B-ultrasound-guided radiofrequency ablation in the treatment of primary liver cancer: Systematic review and metaanalysis

BACKGROUND Primary liver cancer is one of the most lethal malignancies in the world.Tradi-tional treatment methods have limitations in terms of efficacy and safety.Ra-diofrequency ablation(RFA)guided by B-ultrasound,as a minimally invasive treatment,has attracted increasing attention in the treatment of primary liver cancer in recent years.AIM To study the efficacy and safety of RFA were compared with those of traditional surgery(TS)for treating small liver cancer.METHODS At least 2 people were required to search domestic and foreign public databases,including foreign databases such as EMBASE,PubMed and the Cochrane Library,and Chinese databases such as the China National Knowledge Infrastructure database,China Biomedical Literature database,Wanfang database and VIP database.Controlled trials of RFA vs conventional surgery for small liver cancer were retrieved from January 2008 to January 2023.They were screened and eva-luated according to the quality evaluation criteria in the Cochrane Handbook of Systematic Reviews.The meta-analysis was performed using RevMan 5.3 soft-ware.RESULTS A total of 10 studies were included in this study,including 1503 patients in the RFA group and 1657 patients in the surgery group.The results of the meta-ana-lysis showed that there was no significant difference in 1-year overall survival between the two groups(P>0.05),while the 3-year and 5-year overall survival rates and 1-year,3-year and 5-year tumor-free survival rates in the surgery group were greater than those in the RFA group(P<0.05).In terms of complications,the incidence of complications in the RFA group was lower than that in the surgery group(P<0.05).CONCLUSION In terms of long-term survival,TS is better than RFA for small liver cancer patients.However,RFA has fewer complications and is safer.

Effect of CT-Guided Microwave Ablation Combined with TACE on Liver Function and Survival of Patients with Primary Liver Cancer

Objective:To explore the effect of transarterial chemoembolization(TACE)+CT-guided microwave ablation(MWA)on treating patients with primary liver cancer.Methods:78 primary liver cancer cases were enrolled and divided into groups according to their assigned surgical plans.The control group was treated with TACE alone,and the observation group was treated with TACE+CT-guided MWA.The efficacy of the treatment and the liver function indicators and follow-up results of the patients of the two groups were compared.Results:The efficacy of the treatment received by the observation group was higher than that of the control group.Besides,the patients in the observation group exhibited better improvement in liver function indicators after 3 months of treatment.Furthermore,the survival rates of 1 and 2 years after surgery of the observation group were all higher than those of the control group(P<0.05).Conclusion:TACE combined with CT-guided MWA is more effective in treating primary liver cancer compared to TACE alone.Besides,it resulted in better improvement of liver function and long-term survival rate.Therefore,this treatment regime should be popularized.

Ta:后现代女性主义视角下的元宇宙社区

后现代女性主义运动在元宇宙社区中采取了两种话语路径以抵抗男权秩序。第一种路径是通过使用中性的“Ta”话语来实现边缘群体(赛博格、同性恋、双性人等)在主流社会的平等融入。这一路径在元宇宙社区中建立了一个更具包容性和多元性的认知框架和文化秩序。第二种路径是在科学技术层面构建元宇宙社区“Ta”气质概念,以解构“男人/女人”二元不平等的社会秩序。从元宇宙社区主体生存角度来看,“Ta”这一流行语不是一个简单的词汇游戏,而是具有思想史意义上的社会观念革新。然而,尽管后现代女性主义运动在元宇宙社区中通过“Ta”话语努力促进平等和社会观念革新,但其面临的悖论也凸显了在追求变革的道路上所遭遇的困难和挑战,需要不断探索更全面的解决方案。

TA2纯钛薄板微流道液压成形工艺研究

双极板是氢燃料电池的重要部件之一,钛作为金属双极板基材有诸多优势,但钛的成形性能差、回弹较为严重,本文以0.1 mm TA2纯钛薄板微流道液压成形为研究对象,通过试验和有限元模拟相结合的方法研究纯钛微结构变形行为,分析工艺参数对微流道成形质量的影响规律,为液压成形钛双极板提供参考。建立了TA2纯钛薄板微流道液压成形的有限元模型,通过与试验件的轮廓及厚度分布验证有限元模型的准确性;研究了液体压力、加载速率和脉动加载对微流道成形的影响。结果表明,微流道液压成形过程中材料应变路径为平面应变,且上圆角位置最容易破裂;加载速率对微流道成形影响不大,随着加载速率的提高,成形深度略有下降,但是变化不大,仅有3%;脉动加载路径能够提高材料的流动变形能力,在均为临界破裂情况下,相比较线性加载路径成形深度有较高的提高,可达232.2μm,提高幅度为23%。

冷喷涂制备多孔Ta涂层及生物相容性

目的提高生物医用钛合金的生物相容性。方法采用冷喷涂技术在其表面制备了内部多孔且表面粗糙的钽涂层,并对涂层的微观组织、弹性模量、表面粗糙度、孔隙率、相组成等进行表征;通过溶血率实验、动态凝血时间实验、血小板黏附实验和细胞增殖实验等评价其血液相容性。结果涂层表面粗糙度为24.9μm,孔隙率为12.6%,弹性模量为147 GPa。喷涂后涂层相组成为Ta,涂层与基体的结合强度为24 MPa。TC4钛合金基体和钽涂层2种材料均具有优异的红细胞相容性且2种材料表面的动态凝血程度相似,表明在TC4钛合金表面制备钽涂层后,钽涂层不会影响凝血因子的活性。钽涂层具有更好的防止血小板黏附与变形的性能。在细胞增殖实验中,细胞在钽涂层表面的增殖能力略高于TC4钛合金。结论多孔钽涂层的弹性模量相对钽块降低了22%。其生物活性高于TC4钛合金基体。

冷轧和再结晶退火对Ta-2.5W合金组织和力学性能的影响

采用电子束熔炼法制备了Ta-2.5W合金,研究了18.8%、48.5%和75.8%不同冷轧变形量对Ta-2.5W合金显微组织和力学性能的影响,并研究了退火对冷轧Ta-2.5W合金显微组织、性能及织构的影响。结果表明:随着变形量的增加,合金的晶粒不断压扁拉长,变形量75.8%时已经形成明显的纤维组织,合金的硬度和强度随着变形量的增加不断提高,原因是加工硬化。开始变形时合金组织中形成{111}<110>、{111}<121>织构,随着变形量增加,开始出现{100}<110>织构,{111}<121>织构逐渐消失,当变形量达75.8%时主要为{100}<110>织构,只剩下较少的{111}<110>织构;随着退火温度的升高,合金的纤维状组织开始逐渐消失,出现大量的等轴晶粒,发生了再结晶,晶粒尺寸、分布更为均匀,织构强度逐渐降低;1450℃退火保温1 h后,合金再结晶比例达到95.7%,已基本完成再结晶,此时合金中的织构强度大幅降低,约为冷轧态时的50%;退火后合金的强度降低,但塑性显著增加,有利于其后续变形加工。

TA1箔力学性能和断裂行为的尺寸效应

对不同晶粒尺寸的100μm厚TA1箔进行单轴拉伸试验,研究其力学性能和断裂行为的尺寸效应,并构建基于尺寸效应的微尺度本构方程。结果表明,随着晶粒尺寸增大,钛箔的拉伸应力及强度呈现增大的趋势,伸长率先缓慢下降至25%,随后快速降低。拉伸过程中颈缩阶段和平缓阶段不断缩短,除晶粒尺寸为56.88μm的试样外,其余试样断口夹角处于50°~60°,为典型的剪切型断裂。晶粒尺寸超过21.08μm后,断口表面的撕裂棱和韧窝数量不断减少,断裂模式由塑性断裂转变为准解理断裂,晶粒尺寸大于36.14μm后,钛箔基体从HCP-Ti结构转变为FCC-Ti结构,位错密度降低,断口表面出现明显的解理断裂特征,断裂模式完全转变为解理断裂。基于表面层模型构建考虑尺寸效应的本构模型,可精确预测微尺度钛箔拉伸过程中的力学特性。

GO掺杂对TA1钛合金等离子体电解氧化涂层硬度和耐磨性能的影响

本研究在掺杂氧化石墨烯(简称“CO”)的硅酸盐电解液中对TA1钛合金进行等离子体电解氧化处理,旨在获得较高硬度的等离子体电解氧化陶瓷涂层(PEO)。通过表征涂层的物相组成、表面与截面形貌、粗糙度、显微硬度、摩擦因数以及结合力等参数,分析了CO浓度对涂层性能的影响。研究结果表明,CO参与涂层的形成过程,能够有效地减小微孔和裂纹尺寸,表面粗糙度降低。涂层厚度虽然略有降低,但致密性显著增加。与未掺杂GO的PEO涂层相比,当GO掺杂量为0.6g·L^(-1)时掺杂GO的PEO涂层显微硬度提升18.54%,摩擦系数降低84%,临界载荷强度提高32.59%。

弥散加权成像联合动态增强MRI预测肝细胞癌经TACE联合射频消融治疗后复发

目的观察弥散加权成像(DWI)联合动态增强MRI预测肝细胞癌(HCC)经TACE联合射频消融治疗后复发的价值。方法回顾性分析80例接受TACE联合射频消融治疗的HCC患者,均于治疗前10天和治疗后20、60及90天接受腹部DWI及动态增强MR检查;计算DWI联合动态增强MRI预测TACE联合射频消融治疗后20天HCC复发的敏感度、特异度及准确率;绘制受试者工作特征(ROC)曲线,评估以表观弥散系数(ADC)值预测TACE联合射频消融治疗后20天HCC复发的效能。结果参照改良实体瘤疗效评价标准,将47例HCC患者纳入稳定组、33例归为进展组。TACE联合射频消融治疗后20天,稳定组HCC病灶DWI多呈不均匀信号、ADC图呈高信号、增强扫描未见强化,进展组病灶多呈DWI高信号、ADC图低信号、增强扫描轻度强化。DWI联合动态增强MRI预测TACE联合射频消融治疗后20天HCC复发的敏感度、特异度及准确率分别为97.75%(87/89)、92.31%(24/26)及96.52%(111/115)。以ADC值预测TACE联合射频消融治疗后20天HCC复发的曲线下面积为0.82;以ADC=1.42×10^(-3)mm^(2)/s为截断值,预测的敏感度及特异度分别为72.13%及82.25%。结论DWI联合动态增强MRI用于预测TACE联合射频消融治疗后HCC复发具有一定价值;ADC值可作为有效预测指标。

激光选区熔化成形工艺对TA15钛合金内部缺陷与力学性能的影响

利用激光选区熔化(Selective laser melting,SLM)成形技术制备TA15钛合金,通过光学显微镜(Optical microscope,OM)、扫描电镜(Scanning electron microscope,SEM)和室温拉伸等研究了激光功率和扫描速度对SLM成形TA15钛合金内部缺陷与力学性能的影响规律。结果表明:在低激光功率(100~125 W)、高扫描速率(1200~1600 mm/s)区域,激光能量密度较低,合金内部缺陷主要为不规则形状的缺陷;在高激光功率(150~200 W)、低扫描速度(800~1000 mm/s)区域,激光能量密度过高,合金内部缺陷主要为规则球形缺陷。规则球形缺陷的存在会导致合金塑性显著降低、对强度影响较弱;而不规则未熔合缺陷的存在会显著降低合金强度和伸长率。TA15钛合金的最佳工艺参数:激光功率为200 W、激光扫描速度为1600 mm/s时,成形合金拉伸强度为(1291±4.2)MPa,断裂伸长率为(8.5±0.5)%。

热处理对薄壁TA1焊管高频感应焊接接头显微组织和力学性能的影响

首先对壁厚0.4 mm的薄壁TA1焊管进行高频感应焊接,随后,在不同温度下对焊接接头进行5 min的热处理。利用光学显微镜和扫描电镜分析了热处理前后焊接接头的显微组织,并对焊接接头的力学性能进行了测试。结果表明:热处理使TA1焊管焊接接头的显微组织和力学性能发生显著变化,当热处理温度为600℃时,焊接接头发生了完全再结晶,晶粒细小,抗拉强度略有下降,塑性增强,拉伸断口呈典型的韧性断裂特征,这主要是针状马氏体消失和细晶强化所致。

TA18钛合金TIG焊接头组织及耐腐蚀性能研究

采用2B实芯焊丝对12 mm厚的TA18钛合金板进行了TIG焊试验,研究了TA18钛合金TIG焊接头的显微组织,不同腐蚀介质中的电化学和应力腐蚀行为。结果表明:TA18钛合金接头焊缝区域分布大量粗大的柱状晶和少量等轴晶,在盖面、打底及中间填充层存在部分网篮组织;热影响区主要由针状的α’(α’)相、残余α相和β相组成。在3.5%NaCl溶液中进行电化学腐蚀试验,TA18钛合金接头各区域的耐腐蚀性能从高到低为:母材>焊缝>热影响区。比较TA18钛合金接头在大气环境和模拟海水环境中的慢应变速率拉伸应力-应变曲线,表明该接头的力学性能受海水影响不明显,且对海水的应力腐蚀敏感性较低。

TACE联合射频消融治疗复发性肝癌的临床观察

目的探讨肝动脉化疗栓塞术(TACE)联合射频消融(RFA)对复发性肝细胞肝癌的治疗效果。方法选取复发性肝细胞肝癌患者70例,将患者随机分为联合组(35例)和对照组(35例),对照组行TACE治疗,联合组采用TACE联合RFA治疗。比较2组患者治疗前后免疫功能[自然杀伤(NK)细胞、T淋巴细胞分化群4+(CD4+)、CD8+]、肝功能[谷草转氨酶(AST)、丙氨酸氨基转移酶(ALT)]以及肿瘤标志物[癌胚抗原(CEA)、糖蛋白抗原199(CA199)、甲胎蛋白(AFP)]水平,比较2组临床疗效、生存期。结果治疗后,2组CD3+、CD4+、NK细胞水平均升高(P<0.05),且联合组高于对照组(P<0.05)。治疗后,2组血清CEA、AFP、CA199水平均降低(P<0.05),且联合组低于对照组(P<0.05);治疗后,2组血清ALT、AST水平均降低(P<0.05),且联合组低于对照组(P<0.05)。联合组有效率高于对照组(P<0.05);联合组生存期及生存率均高于对照组(P<0.05)。结论TACE联合RFA能够明显改善复发性肝细胞肝癌患者的免疫功能及肝功能,降低肿瘤标志物水平,提高疗效及生存率,延长生存期。

仑伐替尼辅助TACE序贯射频消融治疗乙肝合并晚期肝癌的疗效影响

目的:研究仑伐替尼辅助肝动脉导管化疗栓塞(Transcatheter arterial chemoembolizstion,TACE)序贯射频消融治疗乙肝合并晚期肝癌的疗效影响。方法:以2019年4月至2022年4月我院收治的66例乙肝合并晚期肝癌患者为研究对象,随机分为对照组和观察组,每组各33例。对照组采用TACE序贯射频消治疗,观察组采用仑伐替尼辅助TACE序贯射频消融治疗。治疗前、治疗6 w后比较两组临床疗效、采用全自动生化分析仪测定丙氨酸转氨酶(Alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(Aspartate aminotransferase,AST)、总胆红素(Total bilirubin,TBIL);以酶联免疫吸附法(Enzyme-linked immunosorbent assay,ELISA)测定碱性成纤维细胞生长因子(Basic fibroblast growth factor,bFGF)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)、血管生成素-2(Angiopoietin-2,Ang-2)、以及放射免疫法测定血清低氧诱导因子1α(Hypoxiainduciblefactor1α,HIF-1α)水平;以采用ELISA测定血清胱氨酸天冬氨酸蛋白酶8(Cysteine-containing aspartate-specific proteases8,Caspase8)、可溶性细胞凋亡因子(Soluble factor-related apoptosis,sFas)水平;比较两组不良反应。结果:观察组临床总有效率81.82%(27/33)高于对照组57.58%(19/33)(P<0.05);与治疗前相比,各治疗组的ALT、AST、TBIL水平均明显降低(P<0.05),其中观察组更为显著(P<0.05);与治疗前相比,各治疗组的血清bFGF、HIF-1α、VEGF、Ang-2水平均明显降低(P<0.05),其中观察组更为显著(P<0.05);与治疗前相比,各治疗组的血清Caspase8水平较高,sFas水平较低(P<0.05),其中观察组更为显著(P<0.05);观察组不良反应总发生率18.18%(6/33)与对照组12.12%(4/33)相比,差异无统计学意义(P>0.05)。结论:仑伐替尼辅助TACE序贯射频消融治疗乙肝合并晚期肝癌患者可进一步提升疗效,改善肝功能,调节血管内皮生长因子及凋亡因子水平,且安全可行。