大功率微波消融联合肝动脉化疗栓塞治疗较大肝癌的疗效观察  

An observation on curative effect of high-powered microwave ablation combined with trans-hepatoarterial chemoembolization for treatment of larger hepatocellular carcinoma

作　　者：饶瑶[1] 陆伟[2,3] 张宁宁[4] 王春妍[4] 周莉[4] 李嘉[4] 苏瑞[3,4] 

机构地区：[1]天津医科大学一中心临床学院,天津300192 [2]天津市第一中心医院,天津300192 [3]天津市肝病医学研究所,天津300192 [4]天津市第二人民医院,天津300192

出　　处：《中国中西医结合急救杂志》2016年第2期186-190,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市卫生计生委科技基金项目（2014KZ009）

摘　　要：目的探讨经皮超声引导下大功率微波消融（MWA）联合肝动脉化疗栓塞（TACE）治疗较大肝癌（HCC）的安全性及疗效。方法回顾性分析天津市第二人民医院2013年1月至2014年10月对41例肝癌患者的50个病灶采用大功率MWA联合TACE治疗的临床资料，随访期至2015年10月止。41例患者肿瘤长径3．0～11．6cm，分为病灶3～〈5cm组（37个）和病灶≥5cm组（13个）；观察两组MWA及联合TACE治疗患者的近期疗效、不良反应、局部复发率及生存情况。结果3～〈5em组在行大功率MWA术后肿瘤完全坏死率为86．5％（32／37），高于≥5cm肿瘤的53．8％（7／13，P=0．023）。全部41例患者在MWA术后均联合TACE治疗，其中3．〈5cm组与≥5cm组肿瘤在联合TACE后完全坏死率分别为94．6％和76．9％（P=0．068）；而全部41例患者联合TACE术后的完全坏死率为90．0％（45／50），高于MWA术后的78．0％（39／50），差异有统计学意义（P=0．013）。二者联合治疗术后无手术相关死亡发生，术后肝功能未见明显波动，无肝破裂、肝脓肿、大出m等严重并发症发生。本组部41例患者均完成随访，病灶局部复发率为10％（5／50），1年存活率为92．7％（38／41）。结论经皮超声引导下大功率MWA联合TACE治疗较大肝癌疗效良好，是一种安全、有效、微创的治疗方法。Objective To investigate the safety and curative efficacy of percutaneous uhrasound-guided high-powered microwave ablation （MWA） combined with transcatheter arterial ehemoembolization （TAKE） for treatment of larger hepatocellular carcinoma （HCC）. Methods A retrospective study was conducted. The clinical date of ultrasound-guided high-powered MWA followed by TACE treatment was performed in 41 patients with 50 cancer lesions in Tianjin Second People＇s Hospital from January 2013 to October 2014 were enrolled. All cases were postoperatively followed up for 1 year until October 2015. In 41 patients, the lesions＇ maximum diameters were in the range of 3.0 - 11.6 cm, and they were divided into （3 - 〈 5） cm group with 37 lesions and ≥ 5 cm group with 13 lesions. Short-term curative effect, side effects, the local recurrence rate and survival rate of MWA combined with TACE therapy were observed. Results The complete necrosis rate for the high-powered MWA in the （3 - 〈 5） cm group was significantly higher than that in the ≥ 5 cm group [86.5% （32/37） vs. 53.8% （7/13）, P = 0.023]. All patients received TAkE after high-powered MWA, and the complete necrosis rate after TAkE treatment was 94.6% （35/37） in （3 - 〈 5） cm group and 76.9% （10/13） in the ≥ 5 cm group （P = 0.068）. The complete necrosis rate in all patients after combination with TAkE treatment was 90.0% （45/50） obviously higher than 78.0% （39/50） treated by high-powered MWA （P = 0.013）. After the combination therapy, no death related to the operation occurred; postoperatively, no obvious fluctuation of liver function, hepatic rupture, liver abscess, massive hemorrhage and other severe complications appeared. All patients finished the one-year follow-up, the local recurrence rate of the lesions was 10% （5/50）, and the one-year survival rate was 92.7% （38/41）. Conclusion The treatment of percutaneous ultrasound-guided high-powered MWA combined with TAkE for treatment of larger HCC was a safe

关 键 词：癌 肝细胞 微波消融 大功率 肝动脉化疗栓塞 疗效 

分 类 号：R735.7[医药卫生—肿瘤]