肝动脉栓塞化疗术联合微波消融治疗早期原发性肝癌的疗效观察  

Transcatheter hepatic arterial chemoembolization combined with microwave ablation for the treatment of early primary hepatocellular carcinoma:observation of its efficacy

作　　者：王晓维[1] 蒋逢辰 周水平 付守忠[1] 戴锋[1] 王斌[1] 尹国文[2] WANG Xiaowei;JIANG Fengchen;ZHOU Shuiping;FU Shouzhong;DAI Feng;WANG Bin;YIN Guowen(Department of Vascular Intervention,Nantong Municipal Third People's Hospital(Affiliated Nantong Third Hospital of Nantong University),Nantong,JiangsuProvince 226001,China)

机构地区：[1]南通市第三人民医院(南通大学附属南通第三医院)介入血管科,江苏南通226001 [2]江苏省肿瘤医院(南京医科大学附属肿瘤医院)介入科

出　　处：《介入放射学杂志》2024年第5期488-494,共7页Journal of Interventional Radiology

基　　金：南通市基础科学研究和社会民生科技计划项目(JCZ2022024)。

摘　　要：目的通过对比手术切除(resection,RES),观察肝动脉栓塞化疗(transcatheter hepatic arterial chemoembolization,TACE)联合微波消融(microwave ablation,MWA)治疗早期原发性肝癌的无复发生存率(RFS)、总生存率(OS)以及安全性。方法回顾性分析2013年1月至2018年1月在我院接受治疗的51例肝动脉栓塞化疗术联合微波消融(TACE+MWA组)和58例手术切除(RES组)治疗的单发肿瘤直径≤7 cm或多发肿瘤符合“up-to-7”标准的Ⅰa至Ⅱa期原发性肝癌患者。比较两组患者治疗后的RFS、OS及安全性情况。结果TACE+MWA组1、3、5年RFS分别为84.3%、37.3%、13.7%,RES组1、3、5年RFS分别为67.2%、27.6%、13.8%,其中1年RFS两组对比存在统计学差异(P=0.039),3年及5年RFS两组对比无明显统计学差异(P值分别为0.281、0.992)。TACE+MWA组1、3、5年生存率分别为98%、62.7%、45.1%,RES组1、3、5年生存率分别为94.8%、75.9%、44.8%,两组对比无明显统计学差异(P值分别为0.704、0.137、0.977)。两组均未出现与治疗相关的死亡病例,TACE+MWA组主要表现为一过性栓塞综合征,消融过程中腹痛症状及术后一过性轻中度转氨酶升高。RES组术后主要表现为发热、胸腔积液、腹腔积液、术中出血等,且1例患者术后肝功能损害加重至Child C级。TACE+MWA组住院费用(39834.98±6717.38)元,RES组住院费用(49042.59±11810.69)元,两组对比存在统计学差异(P=0.017)。TACE+MWA组住院时间23 d(19~28 d),RES组住院时间21 d(17~25 d),两组对比无明显统计学差异(P=0.196)。结论肝动脉栓塞化疗术联合微波消融治疗早期肝癌疗效确切,具有安全、经济的优点,可作为单发肿瘤直径≤7 cm或多发肿瘤符合“up-to-7”标准的Ⅰa至Ⅱa期原发性肝癌非手术治疗的优选方案。Objective By comparison with the surgical resection, to evaluate the relapse-free survival(RFS), overall survival(OS), and clinical safety of transcatheter hepatic arterial chemoembolization(TACE)combined with microwave ablation(MWA) in the treatment of early primary hepatocellular carcinoma(HCC).Methods From January 2013 to January 2018 at authors' hospital, 51 HCC patients received TACE combined with MWA(TACE+MWA group) and 58 HCC patients received surgical resection(RES group). The HCC lesions were single tumor with diameter ≤7 cm or multiple tumors with stage Ⅰa-Ⅱa meeting the “up-to-7” criteria. The postoperative RFS, OS, and clinical safety were compared between the two groups. Results The one-, 3- and 5-year RFS in the TACE+MWA group were 84.3%, 37.3% and 13.7% respectively, which in the RES group were 67.2%, 27.6% and 13.8% respectively. The difference in the one-year RFS between the two groups was statistically significant(P=0.039), and the differences in the 3- and 5-year RFS between the two groups were not statistically significant(P=0.281 and P=0.992, respectively). The one-, 3- and 5-year survival rates in the TACE+MWA group were 98%, 62.7% and 45.1% respectively, which in the RES group were 94.8%, 75.9% and 44.8% respectively, and the differences between the two groups were not statistically significant(P=0.704, P=0.137 and P=0.977 respectively). No treatment-related death occurred in both groups.In the TACE +MWA group, the main complications included transient embolism syndrome, abdominal pain during ablation procedure, and mild to moderate transient elevation of transaminase after treatment. In the RES group, the main postoperative complications included fever, pleural effusion, abdominal effusion, and intraoperative bleeding;and in one patient the postoperative liver function impairment worsened to Child grade C. The average cost of hospitalization in the TACE+MWA group was(39 834.98±6 717.38) Chinese yuan,which in the RES group was(49 042.59±11 810.69) Chinese yuan, the difference be

关 键 词：肝癌 肝动脉栓塞化疗 微波消融 手术切除 疗效评估 

分 类 号：R735.7[医药卫生—肿瘤]