TACE联合高强度聚焦超声治疗中晚期肝癌的临床研究  

Clinical study of TACE in combination with high intensity focused ultrasound therapy for advanced stage hepatocellular carcinoma

作　　者：李鹏[1,2] 周丁华[2] 吕伟[2] 赵玮[2] 李春民[2] 

机构地区：[1]山西医科大学研究生学院,山西太原030001 [2]中国人民解放军第二炮兵总医院肝胆外科B区,北京100088

出　　处：《中国现代普通外科进展》2013年第11期870-874,共5页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨肝动脉化疗栓塞(TACE)联合高强度聚焦超声(HIFU)治疗中晚期肝癌的临床疗效。方法:将2010年8月—2012年12月收治的中晚期肝癌47例随机分组,其中实验组25例,行TACE联合HIFU治疗;对照组22例,单纯接受TACE治疗。比较2组的临床症状体征改善状况、甲胎蛋白(AFP)变化、影像学(CT、MRI)变化、外周血T细胞亚群和NK细胞水平的变化以及治疗过程中的并发症。结果:实验组联合治疗后临床症状缓解率为84.0%(21/25),对照组为63.6%(14/22),差异有统计学意义(P<0.05);实验组治疗后AFP转阴或下降超过1/2者为60.0%(15/25),对照组为27.3%(6/22),差异有统计学意义(P<0.05);CT和(或)MRI示:实验组治疗靶区消融效果明显优于对照组;免疫功能变化:实验组治疗后CD3+、CD4+细胞百分数及CD4+/CD8+比值较对照组明显升高,差异均有统计学意义(P均<0.05);2组治疗后均出现不同程度的肝区不适、发热、转氨酶升高、黄疸。实验组HIFU治疗后出现1例轻度皮肤灼伤。结论:TACE联合HIFU治疗可以提高中晚期肝癌治疗效果,改善机体免疫功能,联合治疗的同时并未增加或加重不良反应的发生,是治疗中晚期肝癌较为安全、有效的综合治疗方法。Objective： To investigate the therapeutic effect of TACE combined with high in- tensity focused ultrasound in treating advanced stage hepatocellular carcinoma, Methods： Forty-seven patients suffering from advanced stage hepatocellular carcinoma were randomly divid- ed into two groups in this study from October 2010 to December 2012. The patients in experimental group （n=25） were provided with TACE in combination with HIFU therapy and those in control group （n=22） received TACE treatment alone. The clinical effects, changes of tumor marker AFP, CT or MRI, changes of T-cell subsets and NK cells, and adverse reaction were compared between these two groups. Results： After TACE combined with HIFU treatment, the clinical remission rate of the experimental group was 84% ~21/25）, and the control group was 63.6% （14/22）, there was signifi- cant difference between both groups^P〈0.05）. AFP in both groups were decreased, but in the ex- perimental group much lower than in control group^P〈0.05~. CT or MRI scan showed that the abla- tion effect of the experimental group was significantly better than the control group. The improve- ment of the percentage of CD3＋,CD4＋ cells and the ratio of CD4VCD8~ were better than in control group significantly^P〈0,05）. All cases had different degrees of side effect^discomfort over the liver, fever, rise of ALT, jaundice）. One case of skin burn was observed in experimental group. Conclu- sion： TACE combined with HtFU therapy can increase the treatment efficiency, improve the im- mune function and do not increase the occurrence of complications, which is a safe and effective method in the treatment of advanced stage hepatocellular carcinoma.

关 键 词：肝动脉化疗栓塞 高强度聚焦超声 中晚期肝癌 T细胞亚群 

分 类 号：R735.7[医药卫生—肿瘤]