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中国癌症防治杂志

中国癌症防治杂志

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经肝动脉化疗栓塞联合微波消融治疗中晚期肝癌的临床疗效观察

赵昌;马亦龙;康平;齐锋;欧盛秋;李志坤;蒙志斌;   

  1. 广西医科大学肿瘤医院介入治疗科;
  • 收稿日期:2009-09-25 修回日期:2009-09-25 出版日期:2009-09-25 发布日期:2009-09-25

Clinical review of transcatheter hepatic arterial chemoembolization combined with microwave ablation in patients with advanced liver cancer

ZHAO Chang,MA Yi-long,KANG Ping,et al.   

  1. (Department of Interventional Therapy,Affiliated Tumor Hospital of Guangxi Medical University,Nanning 530021,China
  • Received:2009-09-25 Revised:2009-09-25 Online:2009-09-25 Published:2009-09-25

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被引次数

46

摘要： 目的探讨经导管肝动脉化疗栓塞(TACE)联合经皮微波消融治疗(PMCT)中晚期肝癌的临床疗效及应用价值。方法83例资料完整的中晚期肝癌患者,临床分期为Ⅱa～Ⅲa期,实验组(TACE联合PMCT治疗)28例,对照组55例(单纯TACE治疗)。两组均先行TACE治疗,常规每次治疗后3～4周行CT复查或肝动脉造影,根据碘油缺失、瘘口再通、癌灶残留及病灶进展等情况综合评定,再选择性行TACE或PMCT治疗,连续治疗3次为一个治疗周期。观察比较两组有效率、毒副反应、复发转移率和生存期情况。结果实验组和对照组有效率分别为67.86%和40.00%;实验组和对照组的0.5、1、1.5、2年累积生存率分别为100%、93%、79%、61%和95%、84%、65%、38%;中位生存期分别为30个月和24个月;0.5、1、2年累积复发转移率分别为7.14%、14.29%、32.14%和9.09%、34.55%、65.45%。两组毒副反应相似,均未发生严重并发症。对照组8例合并有肝动-门脉瘘(HAPS)者经TACE术反复封堵后仍有3例发生瘘口再通,实验组5例经TACE+PMCT治疗后未出现瘘口再通。结论TACE联合PMCT治疗中晚期肝癌是安全、可行、有效的治疗方法,其临床疗效优于单纯TACE术治疗,可延长患者生存期,降低复发转移率,不增加毒副反应。

关键词: 中晚期肝癌, 肝动脉化疗栓塞, 经皮微波固化消融, 肝动-门脉瘘

Abstract: Objective To evaluate the clinical effect and application value of transcatheter hepatic arterial chemoembolization(TACE) combined with percutaneous microwave ablation therapy(PMCT) in patients with advanced liver cancer.Methods Eighty-three patients with stage Ⅱa-Ⅲa liver cancer were divided into two groups.Twenty-eight patients undertook the therapy that combined TACE and PMCT as the therapy group.Fifty-five patients performed only with TACE were enrolled in control group.Patients were treated with TACE first.CT inspection or DSA was performed every 3-4 weeks after treatment.TACE or TACE+PMCT were selected again according to the condition of fistula and tumor.Three continuous treatments was a treatment period.Then the therapeutic effect rates,side effects,rates of recurrence and metastasis,survival time of the two groups were followed up.Results The effect rates were 67.86% and 40.00% in the therapy group and control group respectively(P<0.05).The median survival time,and the 0.5-,1-,1.5-,2-year cumulative survival rate were 30 months,100%,93%,79% and 61% in therapy group respectively,while were 24months,95%,84%,65% and 36% in control group respectively(P<0.05).The 0.5-,1-and 2-year cumulative recurrence and metastasis rate were 7.14%,14.29% and 32.14% in therapy group respectively,while were 9.09%,34.55% and 65.45% in control group respectively(P<0.05).All of patients in the two groups had no severe complications.Eight HAPS in the control group were blocked up with TACE,three of them were recanalized later.Five HAPS in the therapy group were completely blocked,but none of them was recanalized.Conclusions TACE combined with PMCT can safely and effectively treat the patients with advanced liver cancer,and can extend life span,reduce the recurrence rate without increasing side effects.

Key words: Advanced liver cancer, Transcatheter hepatic arterial chemoembolization, Percutaneous microwave coagulation therapy, Hepatic artery and portal vein fistula