2018 年第 8 期 第 13 卷

肝动脉化疗栓塞序贯射频消融治疗肝脏多发肿瘤的临床效果

Effect of transcatheter arterial chemoembolization with sequential radiofrequency ablation on liver multiple tumors

作者：肖朝辉王兆海余灵祥孙佳轶刁广浩张绍庚

英文作者：

单位：100039北京，解放军第三○二医院肝胆外科一中心

英文单位：

关键词：肝肿瘤；肝动脉栓塞；射频消融

英文关键词：

• 摘要：

• 【摘要】目的    探讨肝动脉化疗栓塞（TACE）序贯射频消融治疗巴塞罗那肝癌分期（BCLC）B期肝癌的临床效果。方法    回顾性分析2012年5月至2014年6月解放军第三○二医院肝胆外科收治的45例 BCLC B期肝癌患者的病历资料，均进行TACE序贯射频消融治疗。45例患者根据肝癌情况分为结节优势组（16例）：肿瘤数目＞3个，肿瘤直径≤5 cm；直径优势组（29例）：肿瘤数目＞1个且≤3个，其中1个直径≥5 cm。分析TACE序贯射频消融术后血清甲胎蛋白水平变化、近期疗效（缓解率）及远期疗效（生存率）。结果    术后1个月全组患者和结节优势组、直径优势组患者甲胎蛋白水平均明显低于术前［（203±109）μg/L比（453±146）μg/L、（253±121）μg/L比（411±106）μg/L、（199±79）μg/L比（518±156）μg/L］，差异均有统计学意义（均P＜0.05）。术后2个月结节优势组完全缓解和部分缓解分别为10例（62.5%）和3例（18.8%），直径优势组完全缓解和部分缓解分别为22例（75.9%）和4例（13.8%），组间比较差异无统计学意义（P＞0.05）。结节优势组、直径优势组、全组患者3年无瘤生存率分别为18.8%（3/16）、27.6%（8/29）、24.4%（11/45），3年总生存率分别为25.0%（4/16）、37.9%（11/29）、33.3%（15/45），其间差异无统计学意义（P＞0.05）。结论    TACE序贯射频消融是对不可手术切除的BCLC B期肝癌疗效较为确切的治疗手段。

• Objective    To analyze the effect of transcatheter arterial chemoembolization（TACE） with sequential radiofrequency ablation on Barcelona Clinic Liver Cancer（BCLC） stage B patients. Methods    Forty-five BCLC stage B liver cancer patients admitted in the 302th Military Hospital of the Chinese People′s Liberation Army from May 2012 to June 2014 were analyzed. All patients had TACE with sequential radiofrequency ablation. According to the number and diameter of tumors, the patients were divided into group A（number of tumors＞3, diameter of tumors≤5 cm, n=16） and group B（1＜number of tumors≤3, diameter of one of tumors≥5 cm, n=29）. Changes of serum alpha-fetoprotein level before and after operation, short- and long-term curative effects were analyzed. Results    Serum levels of alpha-fetoprotein 1 month after operation of all patients, group A and group B were significantly lower than those before treatment［（203±109）μg/L vs （453±146）μg/L, （253±121）μg/L vs （411±106）μg/L, （199±79）μg/L vs （518±156）μg/L］（P＜0.05）. Two months after treatment, group A had 10 cases（62.5%） of complete remission and 3 cases（18.8%） of partial remission; group B had 22 cases（75.9%） of complete remission and 4 cases（13.8%） of partial remission; there were no significant differences of the remission rates between groups（P＞0.05）. Three-year disease free survival rates of group A, group B and all patients were 18.8%（3/16）, 27.6%（8/29） and 24.4%（11/45）; 3-year overall survival rates were 25.0%（4/16）, 37.9%（11/29） and 33.3%（15/45）; there were no significant differences of the survival rates among groups（P＞0.05）. Conclusion    TACE with sequential radiofrequency ablation has a satisfactory curative effect on BCLC stage B liver cancer.