经导管动脉化疗栓塞术联合冷冻消融治疗不可切除性大肝癌效果与安全性分析  

Efficacy and safety of transcatheter arterial chemoembolization combined with cryoablation in the treatment of unresectable large hepatocellular carcinoma

作　　者：文宠佩 林志东 Wen Chongpei;Lin Zhidong(Department of Interventional Medicine, the Second Affiliated Hospital of Hainan Medical College, Haikou 570311, China)

机构地区：[1]海南医学院第二附属医院介入诊疗科,海口570311

出　　处：《中国综合临床》2018年第4期339-343,共5页Clinical Medicine of China

摘　　要：目的评价应用经导管动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）联合冷冻消融治疗不可切除性大肝癌效果与安全性。方法选择2013年3月至2015年3月于我院就诊的86例不可切除性大肝癌患者，随机分为实验组（43例）和对照组（43例），分别给予TACE联合冷冻消融治疗和单纯TACE治疗，比较两组患者的临床疗效、治疗相关并发症、1年和两年生存率、总生存期（OS）和无进展生存期（PFS），应用Cox回归模型分析影响患者预后的相关因素。结果实验组和对照组的总有效率分别为67.44%（29/43）和46.51%（20/43）（P＝0.049），实验组1年和两年生存率及1年无进展生存率分别为81.40%（35/43）、58.14%（25/43）、53.49% （23/43）,显著高于对照组60.47%（26/43）、34.88%（15/43） 、32.56%（14/43），差异有统计学意义（P＝0.033、P＝3.031、P＝0.049）。对照组与实验组患者3级以上并发症发生率分别为（9.30%（4/43）与13.95%（6/43），差异无统计学意义（P＝0.501）。Cox回归显示，男性（OR＝1.756，95%CI 1.044～3.563，P＝0.041）、低蛋白血症（OR＝1.523，95%CI 1.067～2.891，P＝0.011）和腹腔积液（OR＝1.719，95%CI 1.034～3.108，P＝0.031）不利于患者的预后，TACE＋冰冻消融较TACE单独治疗能更好地改善预后（OR＝0.438，95%CI 0.283～0.712，P＝0.001）。结论在不可切除性大肝癌患者中应用TACE联合冷冻消融治疗具有较好的临床效果和安全性，能够显著改善患者的生存预期。Objective To observe the efficacy and safety of transcatheter arterial chemoembolization combined with cryoablation in the treatment of unresectable large hepatocellular carcinoma.Methods Eighty-six patients with unresectable large hepatocellular carcinoma treated in the Second Affiliated Hospital of Hainan Medical College from March 2013 to March 2015 were selected and were randomly divided into the experimental group （43 cases） and the control group （43 cases）, and were treated with transcatheter arterial chemoembolization（TACE） combined with cryoablation therapy and TACE therapy alone.The clinical efficacy, complications related to treatment, 1-year and 2-year survival rate, overall survival and progression free survival of the two groups were compared and analyzed.The COX regression analysis was used to observe the prognostic factors.Results The total effective rate in experimental group was higher than that in the control group （67.44 % （29/43） vs.（46.51% （20/43）, P=0.049）. The 1-year survival rate, 2-year survival rate and 1-year PFS rate of the experimental group were significantly higher than those in the control group （81.40% （35/43） vs.60.47% （26/43）, 58.14% （25/43） vs.34.88% （15/43）, 53.49% （23/43） vs.32.56% （14/43）, P=0.033, 3.031, 0.049）. There was no significant difference in the incidence of complications at grade 3 or above between the control group and experimental group （ （9.30% （4/43） vs.13.95% （6/43）, P=0.501）. COX regression analysis showed that male （OR=1.756, 95%CI 1.044-3.563, P=0.041）, hypoproteinemia （OR=1.523, 95%CI 1.067-2.891, P=0.011） and ascites （OR=1.719, 95%CI 1.034-3.108, P=0.031） were unfavorable to the prognosis of patients.TACE combined with cryoablation were more effective in improving the prognosis than TACE alone （OR=0.438, 95%CI 0.283-0.712, P=0.001）.Conclusion TACE combined with cryoablation is an effective and safe therapy, it also can obviously improve the survival expectancy for patient

关 键 词：肝细胞肝癌 经导管动脉化疗栓塞术 冷冻消融术 

分 类 号：R735.7[医药卫生—肿瘤]