TACE联合冷循环PMCT治疗原发性肝癌的临床应用  

Clinical Application of Transarterial Chemoembolization Combining with Air-Cooled Percutaneous Microwave Coagulation Therapy on Patients with Primary Hepatic Carcinoma

作　　者：许林锋[1] 陈耀庭[1] 任强[1] 马海清[1] 张靖[1] 陈斌[1] 陆佩霞[1] 谭绮云[1] 

机构地区：[1]中山大学附属第二医院介入放射科,广州市510120

出　　处：《中国肿瘤临床》2007年第10期553-557,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:评价肝动脉化疗栓塞(TACE)联合冷循环经皮微波凝固治疗(PMCT)原发性肝癌的临床疗效。方法:71例确诊为原发性肝癌的患者,分期是Ⅰa～Ⅲa,随机分为治疗组(PMCT和TACE联合治疗组)33例,对照组(TACE组)38例。治疗组患者先行TACE治疗,2～4周后根据复查的AFP和CT/MR等的影像学检查决定再次行TACE或者PMCT。随访时间5～48个月(平均25.5个月),随访内容包括AFP、肝功能、影像学资料、并发症等。根据随访的生存时间、复发情况作统计学分析。结果:治疗组和对照组治疗的肝癌患者的1、2、3年累积生存率分别是84.23%、72.29%、61.96%和55.84%、22.79%、11.40%,治疗组和对照组治疗的肝癌患者的6个月、12个月、24个月累积复发率分别6.06%、9.09%、24.24%和7.89%、31.57%、60.52%。TACE联合PMCT治疗肝癌没有严重并发症,对肝功能的损害轻。治疗组33例有5例合并动静脉瘘(AVF),经动脉栓塞治疗后2例AVF消失,3例治疗后效果不理想的患者行PMCT后AVF消失。结论:本组研究初步显示,TACE联合PMCT治疗原发性肝癌是安全、有效、可行的方法,在治疗原发性肝癌的临床应用近、中期的效果好。PMCT提供了治疗肝癌合并AVF新的方法。Objective： To evaluate the clinical effectiveness of transarterial chemoembolization （TACE） combining with air-cooled percutaneous microwave coagulation therapy （PMCT）. Methods： Seventy-one patients with Stage Ⅰ a to Ⅲ a hepatocellular carcinoma （HCC） were divided into two groups： 33 patients of the therapeutic alliance group （group A） received a combined treatment of TACE plus PMCT and 38 of the control group （group B） took the TACE only. Patients were treated with TACE first, and after a period of 2 to 4 weeks, a decision for repeated TACE or PMCT would be made based on the AFP reexamination and imageological examinations such as CT or MR. The follow-up time ranged from 5 to 48 months （averaging 25.5 months）, including the AFP, liver function, imaging data and complications. Statistical analysis was conducted based on the survival time and recurrence in the follow-ups. （TACE only, n=38）. Results： The 1, 2 and 3-year accumulative survival rate were 84.23%, 72.29%, and 61.96% in the group A, and were 55.84%, 22.79% and 11.40% in the group B respectively （P〈0.05）. And the 0.5, 1 and 2-year cumulative recurrence rate were 6.06%, 9.09% and 24.24% in group A, and 7.89%, 31.57% and 60.52% in group B respectively （P〈0.05）. No severe complication was found in patients with the combined treatment of TACE plus air-cooled PMCT, and impairment of the drugs on liver functions was slight. Five of the 33 cases complicating with arteriovenous fistula （AVF） were treated with transcatheter arterial embolization （TAE）. AVF disappeared in 2 cases but existed in 3, after TAE treatment. The AVF disappeared later in the latter 3 cases after a PMCT was performed. Conclusion： The initial results of the study show that the treatment method of primary hepatic carcinoma （PHC） in the group A is safe, effective and feasible, with a better short-term and mediumterm effectiveness. PMCT may offer a new method for treating HCC patients with a complication of AVF.

关 键 词：原发性肝癌 肝动脉化疗栓塞 经皮微波凝固治疗 动静脉瘘 

分 类 号：R735.7[医药卫生—肿瘤]