肝动脉导管化疗栓塞序贯经皮微波消融治疗原发性肝癌的临床应用

目的:探讨肝动脉导管化疗栓塞(TACE)序贯B超/CT精准引导下经皮微波消融(MWA)在原发性肝癌中的治疗应用,分析比较疗效。方法:回顾性分析2016年1月至2018年7月在上海交通大学附属第一人民医院接受治疗的96例原发性肝癌患者,42例行TACE序贯联合B超/CT精准引导下MWA治疗(联合组),另54例仅行单纯TACE治疗(TACE组)。术后1月、3月、6月、1年、2年复查增强CT/MRI、AFP、肝功能,随访2年比较两组患者肿瘤坏死、复发、进展和生存情况,评价两组疗效。结果:联合组肿瘤坏死率92.9%,TACE组肿瘤坏死率48.1%,差异有统计学意义(P0.05);联合组肿瘤复发率7.1%,TACE组肿瘤复发率24.1%,差异有统计学意义(P0.05);联合组肿瘤进展率19.1%,TACE组肿瘤进展率27.8%,差异无统计学意义(P0.05);联合组肿瘤进展时间13.2个月,TACE组肿瘤进展时间7.6个月,差异有统计学差异(P0.05);联合组1年生存率83.3%,TACE组1年生存率57.4%,差异有统计学意义(P0.05);联合组2年生存率62%,TACE组2年生存率31.5%,差异有统计学意义(P0.05);联合组中位生存时间28.9个月,TACE组中位生存时间16.9个月,差异有统计学意义(P0.05)。结论:TACE序贯MWA治疗肝癌安全有效,互补增益,是肝癌综合治疗的新模式。

Clinical Value of Transcatheter Arterial Chemoembolization Followed by Percutaneous Microwave Ablation for Hepatocellular Carcinomas

ABSTRACT Objective: To explore the Clinical value of transcatheter arterial chemoembolization (TACE) followed by percutaneous microwave ablation (MWA) for hepatocellular carcinomas, and to analyze the efficacy. Methods: A retrospective analysis of 96 patients with primary liver cancer treated at the First People''s Hospital of Shanghai Jiaotong University from January 2016 to July 2018, 42 patients underwent TACE sequential combined with B-ultrasound/CT-guided MWA treatment (Combined group), another 54 patients were treated with TACE alone (TACE group). CT, MRI, AFP and liver function were enhanced at 1 month, 3 months, 6 months, 1 year and 2 years after treatment. Tumor necrosis, recurrence, progression and survival were compared between the two groups. The efficacy of the two groups was evaluated. Results: The tumor necrosis rate was 92.9 % in the combined group and 48.1 % in the TACE group, the difference was statistically significant (P<0.05). The tumor recurrence rate was 7.1 % in the combined group and 24.1 % in the TACE group, the difference was statistically significant (P<0.05). The tumor progression rate was 19.1 % in the combined group and 27.8 % in the TACE group, the difference was not statistically significant (P>0.05). The median progression time was 13.2 months in the combined group and 7.6 months in the TACE group, the difference was statistically significant (P<0.05). The 1-year survival rate of the combined group was 83.3 % and 57.4 % in the TACE group, the difference was statistically significant (P<0.05). The 2-year survival rate of the combined group was 62 % and 31.5 % in the TACE group, the difference was statistically significant (P<0.05). The median survival time was 28.9 months in the combined group and 16.9 months in the TACE group, the difference was statistically significant (P<0.05). Conclusion: TACE sequential MWA is safe and effective in the treatment of liver cancer, and can complement each other. It is a new model for comprehensive treatment of liver cancer.