X －刀联合介入栓塞治疗原发性肝癌近期疗效观察

目的：探讨经肝动脉化疗栓塞（TACE）结合立体定向体部 X －刀治疗肝癌的临床疗效。方法：回顾性分析我院2012年3月－2013年11月治疗的原发性肝癌患者96例的临床资料，随机分成三组，X －刀组、TACE 组以及联合组（X －刀联合 TACE）各32例。观察指标主要包括：客观疗效、甲胎球蛋白（AFP）、肝脏功能（ALT，AST）、肾脏功能（BUN，Cr）、毒副反应、生存时间。结果：所选择的各分类病人的一般资料对比情况，包括性别、乙肝表面抗原状况及 Child －pugh 评分（A ／B）等方面，其差异不具有统计学意义（P ＞0．05），具有可比性。近期疗效情况：治疗结束1月后，与单纯的 TACE 组相对比，单纯 X －刀治疗组病人总体有效率差异无统计学意义（有效率：28．13％ vs 21．88％，P ＝0．564）；与单纯 TACE 治疗组比较，联合治疗组病人总的有效率显著升高，差异具有统计学意义（有效率：46．88％ vs 21．88％，P ＝0．035）。生存时间：联合组、单纯 X －刀组、单纯 TACE 组三组的生存时间分别为（13．2±2．6）个月、（8．8±2．2）个月、（5．8±2．1）个月。联合组与单纯 TACE 组及单纯 X －刀组比较，生存时间有所延长，差异具有统计学意义。治疗结束1月后与单纯 TACE组比较，联合治疗组病人卡氏评分高，差异具有统计学意义（t ＝2．18，P ＝0．0331）。三组治疗后肝、肾脏功能均较本组病人治疗前改善，差异具有统计学意义（P ＜0．05）；三组病人治疗后肝肾功能组间相比较无统计学意义（P ＞0．05）。结论：TACE 与 X －刀治疗相结合的方法治疗原发性肝癌在临床上有着显著的疗效，较单纯TACE 治疗组能起到更为有效的抑制和杀伤肿瘤的作用。TACE 与 X －刀治疗方法相结合无疑较单纯 TACE治疗组和单纯 X －刀治疗组能更好的改善患者的近期生存质量，并且能在一定程度上延长患者的生存时间，不失为是一种风险低、临床有效率高、并发症并不增多的有效治疗方案之一。TACE 与 X －刀治疗相结合的治疗方案治疗原发性肝癌较单纯 TACE 治疗组和单纯 X －刀治疗组对胃肠道功能以及肾脏机能损害减小，并且患者能够耐受，并发症风险低。

Recent curative effect of X -knife with TACE on the primary liver cancer

Objective:To analyze the clinical efficacy of conventional TACE combined with stereotactic body X knife treatment on liver cancer.Methods:Retrospectively analyze data of 96 primary liver cancer patients who were randomly divided into three groups,X -knife group,TACE group,X -knife combined with TACE group,32 cases in each.Observation indicators mainly include objective effect,AFP,ALT,AST,kidney (BUN,Cr),side effects,and sur-vival.Results:General date of three groups of patients,including gender,HBSAg (+),and the Child -pugh score (A /B)were compared,the difference had no statistical significance (P >0.05).After 4 week's treatment,curative effects were compared among three groups.The difference between X - knife group and conventional TACE alone group was not statistically significant (incidences of efficiency:28.13% vs 21.88%,P >0.05).Joint group had bet-ter curative effects than conventional TACE group,with statistical differences between two groups(incidences of effi-ciency:46.88% vs 21.88%,P <0.05).The survival time of joint group,simple X -knife,TACE alone group were (13.2 ±2.6)months,(8.8 ±2.2)months,(5.8 ±2.1)months.Survival time of joint group was prolonged com-pared with X -knife group and conventional TACE alone group,the difference was statistically significant.Joint group had a high score of KPS after treatment.Liver and kidney function of all the three groups were improved than before the treatment (P <0.05).There was no significant difference (P >0.05)among the liver and kidney function of three groups after the treatment.Conclusion:Combined with conventional X -knife treatment of primary liver cancer treatment has obvious curative effect,more effective than conventional TACE group.Combined with conventional X -knife treatment for primary liver cancer than conventional treatment group and X -knife can improve the patient's quality of life,prolong patient survival.