经肝动脉化疗栓塞与射频消融和无水乙醇注入对大肝癌的疗效评价及预后分析  

Transcatheter arterial chemoembolization combined with radiofrequency ablation and percutaneous ethanol injection for large hepatocellular carcinoma:therapeutic evaluation and prognosis analysis

作　　者：孟庆雯[1] 李勇[1] 胡宝山[1] 邵培坚[1] 占美晓[1] 赵岩[1] 黄建文[1] 何旭[1] 陆骊工[1] 

机构地区：[1]广东省医学科学院广东省人民医院介入科,广州510080

出　　处：《介入放射学杂志》2013年第8期646-649,共4页Journal of Interventional Radiology

基　　金：广东省科技计划项目基金(2011A030400009)

摘　　要：目的探讨肝动脉化疗栓塞(TACE)联合射频消融(RFA)及无水乙醇注入术(PEI)治疗原发性大肝癌的临床效果及预后情况。方法选取2006年至2010年诊治的原发性大肝癌92例,其中15例行TACE联合RFA(Ⅰ组),29例行TACE联合PEI(Ⅱ组),21例行TACE、RFA联合PEI(Ⅲ组),仅行TACE 27例(Ⅳ组)。分析比较4组的临床疗效及总生存时间(OS),用COX比例风险模型分析预后因素。结果 4组相比,肿瘤缩小及肿瘤坏死率均有统计学意义(P=0.008,P=0.026);Ⅰ、Ⅱ、Ⅲ和Ⅳ组OS分别为18、14、20和10个月,差异有统计学意义(P=0.000);多因素结果分析显示,门脉癌栓及术前AFP值是影响总生存时间的预后因素(P=0.028,P=0.031)。结论 TACE、RFA联合PEI治疗大肝癌与TACE联合RFA/PEI或TACE相比,可明显提高肿瘤缩小、坏死率,延长生存期。Objective To in vestigate the clinical effectiveness of transcatheter arterial chemoembolization（TACE） combined with radiofrequency ablation（RA） and percutaneous ethanol injection（PEI） for the treatment of large hepatocellular carcinoma.Methods Ninety two patients with large hepatocellular carcinoma,who were encountered at authors’ hospital during the period from 2006 to 2010,were enrolled in this study.TACE together with RFA was carried out in 15 cases（group A）,TACE together with PEI was employed in 29 cases（group B）,TACE combined with RFA and PEI was adopted in 21 cases（group C）,and only TACE was used in 27 cases（group D）.The clinical effects and overall survival time were analyzed and compared between each other of the four groups,and the factors influencing prognosis were evaluated by using Cox proportional hazards model.Results The differences in the diminution rate of tumor size and lesion necrosis rate between each other of the four groups were statistically significant（P = 0.008,P = 0.026）.The overall survival time of the group A,B,C and D was 18,14,20 and 10 months respectively,and the difference between each other of the four groups was statistically significant（P = 0.000）.Cox regression analysis indicated that portal vein tumor thrombus and the preoperative AFP level were two unfavorable prognostic factors influencing the overall survival time（P = 0.028,P = 0.031）.Conclusion Compared with TACE ＋ RFA or TACE ＋ PEI,TACE ＋ RFA ＋ PEI can more markedly reduce the tumor size,increase tumor necrosis rate and elongate the survival time.

关 键 词：原发性大肝癌 肝动脉化疗栓塞术 射频消融 经皮无水乙醇注入 

分 类 号：R735.7[医药卫生—肿瘤]