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目的 探讨超声引导下经皮微波消融与肝动脉化疗栓塞治疗原发性肝癌的临床效果.方法 选择原发性肝癌患者86例作为研究对象,根据随机数字表法分为观察组与对照组各43例,对照组给予肝动脉化疗栓塞治疗,观察组给予超声引导下经皮微波消融治疗,记录两组近远期预后.结果 两组治疗前ALT、AST水平比较均无明显差异(P>0.05),治疗后5 d观察组的ALT、AST水平明显低于对照组(P<0.05).观察组与对照组的治疗总有效率分别为76.7%和53.5%,观察组的总有效率明显高于对照组(P<0.05).两组治疗后3个月的感染、高热、腹水、消化道出血等并发症发生情况与对照组比较差异无统计学意义(P>0.05).观察组治疗后6个月及1年的死亡率分别为2.3%与7.0%,对照组分别为14.0%和27.9%,观察组明显低于对照组(P<0.05).结论 相对于肝动脉化疗栓塞,超声引导下经皮微波消融治疗原发性肝癌也具有很好的安全性,对肝脏损害较轻,能提高治疗效果,延长患者的生存时间. 相似文献
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经肝动脉化疗栓塞联合微波消融治疗中晚期肝癌的临床疗效观察 总被引:3,自引:0,他引:3
目的 探讨经导管肝动脉化疗栓塞(TACE)联合经皮微波消融治疗(PMCT)中晚期肝癌的临床疗效及应用价值.方法 83例资料完整的中晚期肝癌患者,临床分期为Ⅱa~Ⅲa期,实验组(TACE联合PMCT治疗)28例,对照组55例(单纯TACE治疗).两组均先行TACE治疗,常规每次治疗后3~4周行CT复查或肝动脉造影,根据碘油缺失、瘘口再通、癌灶残留及病灶进展等情况综合评定,再选择性行TACE或PMCT治疗,连续治疗3次为一个治疗周期.观察比较两组有效率、毒副反应、复发转移率和生存期情况.结果 实验组和对照组有效率分别为67.86%和40.00%;实验组和对照组的0.5、1、1.5、2年累积生存率分别为100%、93%、79%、61%和 95%、84%、65%、38%;中位生存期分别为30个月和24个月;0.5、1、2年累积复发转移率分别为7.14%、14.29%、32.14%和9.09%、34.55%、65.45%.两组毒副反应相似,均未发生严重并发症.对照组8例合并有肝动-门脉瘘(HAPS)者经TACE术反复封堵后仍有3例发生瘘口再通,实验组5例经TACE+PMCT治疗后未出现瘘口再通.结论 TACE联合PMCT治疗中晚期肝癌是安全、可行、有效的治疗方法,其临床疗效优于单纯TACE术治疗,可延长患者生存期,降低复发转移率,不增加毒副反应. 相似文献
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目的探讨肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗中晚期肝癌的临床疗效。方法62例具有介入治疗指征的中晚期肝癌患者随机均分为2组,对照组31例单独行TACE治疗,观察组31例行TACE联合RFA治疗。比较观察2组的临床疗效及AFP水平。结果观察组总有效率为87.1%,高于对照组的51.6%(P〈0.05)。观察组术后AFP水平明显低于对照组(P〈0.05)。随访24个月各时期的生存率观察组均明显高于对照组(P〈0.05)。结论TACE联合RFA治疗中晚期肝癌安全、可靠,可提高患者生存率,延长患者生存时间,疗效优于单独应用TACE。 相似文献
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目的:观察肝动脉化疗栓塞(TACE)联合微波消融(PMCT)治疗原发性中晚期肝癌的临床疗效。方法:选取不能手术切除的原发性中晚期肝癌患者150例,行TACE治疗的80例作为对照组,行TACE联合PMCT治疗的70例患者作为联合组,比较两组甲胎蛋白平均下降率、总有效率、生存率及毒副反应。结果:对照组和联合组甲胎蛋白(AFP)下降率分别为46.3%和76.8%;总有效率分别为58.8%和78.6%;0.5、1、1.5、2年的生存率分别为91.3% 、77.5%、45.0%、11.3%和97.1%、82.9%、61.4%、31.4%;两组均未发生严重毒副反应。结论:TACE 联合PMCT治疗中晚期肝癌安全、有效、可行,临床疗效优于单纯TACE治疗,可提高患者生存期,改善患者的生活质量。 相似文献
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《中国肿瘤临床与康复》2019,(5)
目的探讨高频热消融和微波热消融联合肝动脉化疗栓塞术(TACE)治疗中晚期原发性肝癌的临床疗效。方法选取2015年8月至2018年8月间成都三六三医院收治的86例中晚期原发性肝癌患者,采用随机数表法分为治疗组和对照组,每组43例。对照组患者采用单纯TACE术治疗,治疗组患者采用高频热消融、微波热消融联合TACE术治疗,比较两组患者术后疗效、生存时间、血清甲胎蛋白(AFP)水平及并发症情况。结果治疗组患者临床总有效率为97. 7%,优于对照组的86. 0%,差异有统计学意义(P <0. 05)。两组患者术后出现胃肠道不适、肝功能损伤、疼痛及发热等并发症情况比较,差异均无统计学意义(P> 0. 05)。术前,两组患者血清AFP水平比较,差异无统计学意义(P> 0. 05)。术后,两组患者血清AFP水平均下降,且治疗组下降程度大于对照组,差异均有统计学意义(均P <0. 05)。两组患者术后3个月和6个月生存率比较,差异无统计学意义(P> 0. 05)。术后12个月和24个月,对照组患者生存率均低于治疗组,差异均有统计学意义(均P <0. 05)。结论高频热消融、微波热消融联合TACE术治疗中晚期原发性肝癌患者,临床疗效满意,值得临床推广。 相似文献
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目的探讨肝动脉化疗栓塞(TACE)联合微波消融(MWA)治疗大肝癌的疗效及预后影响因素。方法对32例大肝癌患者行TACE联合MWA治疗。结果 32例患者中CR 9.4%(3/32),PR 56.3%(18/32),SD 25.0%(8/32),PD 9.4%(3/32),中位生存时间为(19.0±2.7)个月,1、2年生存率分别为66.1%和36.9%。单因素及Cox回归分析显示,肿瘤大小、Child分级、病灶数目、是否伴有门静脉血栓均是影响患者预后的独立因素。结论 TACE联合MWA治疗大肝癌是1种安全有效的治疗方式,值得临床推广应用。 相似文献
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目的:评价肝动脉化疗栓塞同步联合多源微波消融治疗大肝癌的安全性及疗效。方法:回顾性分析我院2015年7月至2016年6月收治的22例大肝癌患者,肿瘤平均最大径为9.33±3.23cm。所有患者采用肝动脉化疗栓塞同步联合多源微波消融治疗。治疗前后行肝肾功能检查,治疗后1个月行增强MRI检查,采用mRECIST标准对疗效进行评估。计量资料采用t检验分析,采用Kaplan-Meier法计算无进展生存时间(PFS)和总生存时间(OS)。结果:所有患者均成功完成同步联合治疗。治疗后3天内谷丙转氨酶(ALT)、谷草转氨酶(AST)和总胆红素(TBiL)出现一过性升高,白蛋白(ALB)、肌酐(CRE)和凝血酶原时间(PT)等指标在治疗前后无统计学差异(P>0.05)。患者术后出现疼痛15例(68.2%);发热1例(4.5%);右侧胸腔积液6例(27.3%);肝包膜下出血1例(4.5%)。治疗后1个月影像学评价为CR者8例(36.4%),PR者14例(63.6%)。平均随访时间11.42±3.81个月,1年PFS率为32.3%,1年OS率为74.4%。结论:肝动脉化疗栓塞同步联合多源微波消融治疗大肝癌安全有效。 相似文献
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探讨联合应用经肝动脉化疗栓塞联合微波刀治疗中晚期肝癌的临床应用价值。方法:收集经病理、AFP和(或)影像学证实的不能手术切除的中晚期肝癌患者63例,按治疗方法随机分为经肝动脉化疗栓塞治疗组和经肝动脉化疗栓塞联合微波刀治疗组,经肝动脉化疗栓塞治疗组31例,联合治疗组32例。结果:经肝动脉化疗栓塞治疗组与联合治疗组治疗后患者AFP定量平均下降率分别为52.2%(12/23)和80.0%(20/25),两组间差异有统计学意义(P<0.05);经肝动脉化疗栓塞治疗组的完全坏死率为12.9%(4/31);而联合治疗组的完全坏死率为34.4%(11/32),经统计学分析两组有明显统计学意义。经肝动脉化疗栓塞治疗组在1个疗程治疗结束6个月后复查影像学发现肝癌复发率为32.3%(10/31);联合治疗组肝癌复发率为9.4%(3/32),两者间差异有显著意义(P<0.05)。经肝动脉化疗栓塞治疗后患者1年的生存率为64.5%(18/31),而经联合治疗后患者1年生存率为87.5%(28/32),两组间差异有统计学意义(P<0.05)。结论:经肝动脉化疗栓塞联合微波消融治疗可显著提高中晚期肝癌患者的生存率,延长患者生存期。 相似文献
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目的:比较微波消融术( microwave ablation,MWA)联合或者不联合经肝动脉化疗栓塞术( transcathe-ter arterial chemoembolization,TACE)治疗肝细胞癌( HCC)的临床疗效以及不良反应。方法:选择89例2006年10月至2009年7月入我院治疗的肿瘤直径≤5cm的原发性肝细胞癌患者,采用随机数字法分为MWA联合TACE组(n=44)或者单独MWA组(n=45)进行随机对照研究,观察两组患者的总生存率(OS)、无复发生存率( RFS)以及不良反应。结果:所有患者均治疗成功,随访时间为7-62个月,随访结束时联合组患者死亡15人,微波组死亡23人。联合组、微波组分别有16人、25人出现疾病进展。1年、2年、3年OS分别为86.4%,74.4%,61.8%和77.4%,63.6%,50.0%。对应的RFS为72.4%,61.6%,45.8%和61.7%,52.2%,39.8%。联合组的OS以及RFS高于单纯微波组(风险比率HR为0.323,95%CI为0.295-0.351,P=0.002;风险比率HR为0.258,95%CI为0.230-0.286,P=0.02)。研究过程中无治疗相关性死亡。对相关因素进行Logistic回归分析,治疗分配、肿瘤大小、肿瘤数目是OS相关预后因素,治疗分配、肿瘤大小是RFS相关预后因子。结论:MWA联合TACE术治疗病灶≤5cm的HCC患者疗效优于单独的MWA治疗疗效。 相似文献
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Z.-W. Peng M.-S. Chen H.-H. Liang H.-J. Gao Y.-J. Zhang J.-Q. Li Y.-Q. Zhang W.Y. Lau 《European journal of surgical oncology》2010
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To assess whether combining percutaneous radiofrequency ablation (PRFA) with transcatheter arterial chemoembolization (TACE) was better than PRFA alone for hepatocellular carcinoma (HCC).Materials and methods
One hundered twenty patients (with a solitary HCC ≤ 7.0 cm in diameter or multiple HCC (≤3), each ≤3.0 cm in diameter) treated with PRFA combined with TACE were compared with 120 well-matched controls selected from a pool of 652 patients who received PRFA alone during the study period.Results
The 1-, 2-, 3-, 5-year overall survival rates for the TACE-PRFA and PRFA groups were 93%, 83%, 75%, 50%, and 89%, 76%, 64%, 42%, respectively (p = .045). Subgroup analyses showed the survival for the TACE-PRFA group was better than the PRFA group for tumors >5.0 cm (p = .031) and for multiple tumors (p = .032), but not for tumors ≤5.0 cm (p = .319) and for solitary tumor (p = .128). The 1-, 2-, 3-, 5-year progression free survival (PFS) for the TACE-PRFA and PRFA groups was 90%, 76%, 63%, 42%, and 76%, 60%, 47%, 30%, respectively (p = .002). Child-pugh class, Diameter of tumor and hepatitis B surface antigen (HBsAg) were significant prognostic factors.Conclusion
Patients treated with TACE-PRFA had better overall survivals than PRFA alone, but only in a subgroup of patients with tumor >5 cm or multiple tumors. 相似文献13.
目的:系统评价射频消融(RFA)联合肝动脉栓塞化疗(TACE)治疗原发性肝癌(hepatocellular carci-noma,HCC)的临床疗效。方法:计算机检索Cochrane Library、PubMed、中国知网数据库、中国生物医学文献数据库、中文科技期刊全文数据库,检索时间从数据库建库至2011年12月20日,同时辅助其它检索,纳入RFA联合TACE治疗HCC的临床对照试验。评价纳入研究的质量并提取资料,并用RevMan 5.1软件进行统计分析。结果:共纳入14篇临床对照试验,分析结果显示:与单纯TACE相比,TACE联合RFA能提高HCC治疗的有效率(RR=1.21,95%CI:1.13-1.31,P<0.001)和肿瘤完全坏死率(RR=1.95,95%CI:1.22-3.10,P=0.005),提高AFP转阴率(RR=2.13,95%CI:1.04-4.38,P=0.04)及患者1年(RR=1.38,95%CI:1.18-1.60,P<0.0001)、2年(RR=1.6 6,9 5%CI:1.3 9-1.9 9,P<0.0 0 0 0 1)、3年(RR=2.11,95%CI:1.57-2.84,P<0.00001)生存率,降低癌症复发率(RR=0.55,95%CI:0.33-0.91,P=0.02)。结论:TACE联合RFA可提高HCC治疗有效率和生存率,降低复发率,值得临床推广使用。 相似文献
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Yongxiang Yi Yufeng Zhang Qiang Wei Liang Zhao Jianbo Han Yan Song Ying Ding Guilan Lu Junmao Liu Huaiying Ding Feng Dai Xiaojun Tang 《中国癌症研究》2014,26(1):112-118
Objective:To compare radiofrequency ablation (RFA) or microwave ablation (MWA) and transcatheter arterial chemoembolization (TACE) with RFA or MWA monotherapy in hepatocellular carcinoma (HCC).Methods:A prospective,randomized,controlled trial was conducted on 94 patients with HCC ≤7 cm at a single tertiary referral center from June 2008 to June 2010 at the Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Southeast University.The patients were randomly assigned into the TACERFA or TACE-MWA (combined treatment group) and the RFA-alone or MWA-alone groups (control group).The primary end point was overall survival.The secondary end point was recurrence-free survival,and the tertiary end point was adverse effects.Results:Until the time of censor,17 patients in the TACE-RFA or TACE-MWA group had died.The median follow-up time of the patients who were still alive for the TACE-RFA or TACE-MWA group was 47.5±11.3 months (range,29 to 62 months).The 1-,3-and 5-year overall survival for the TACE-RFA or TACE-MWA group was 93.6%,68.1% and 61.7%,respectively.Twenty-five patients in the RFA or MWA group had died.The median follow-up time of the patients who were still alive for the RFA or MWA group was 47.0±12.9 months (range,28 to 62 months).The 1-,3-and 5-year overall survival for the RFA or MWA group was 85.1%,59.6% and 44.7%,respectively.The patients in the TACE-RFA or TACE-MWA group had better overall survival than the RFA or MWA group [hazard ratio (HR),0.526; 95% confidence interval (95% CO,0.334-0.823; P=0.002],and showed better recurrence-free survival than the RFA or MWA group (HR,0.582; 95% CI,0.368-0.895; P=0.008).Conclusions:RFA or MWA combined with TACE in the treatment of HCC ≤7 cm was superior to RFA or MWA alone in improving survival by reducing arterial and portal blood flow due to TACE with iodized oil before RFA. 相似文献
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射频消融术联合肝动脉化疗栓塞治疗肝癌的临床效果 总被引:1,自引:0,他引:1
目的探讨射频消融术后联合肝动脉化疗栓塞对肝癌的治疗效果。方法25例肝癌患者共34个瘤灶,中等大小肿瘤(3 cm~5 cm)9个,大肿瘤(>5.1 cm)25个。射频消融术后2~10周行肝动脉化疗栓塞术。治疗效果采用增强CT扫描和临床随访评估。结果射频消融术后CT扫描见治疗区仍有残留癌灶。化疗栓塞后CT扫描见大部分残留癌灶碘油沉积良好。16例患者AFP转阴或明显下降。24例获随访,累计生存率>1年(87.9%),>2年(70.8%)。结论射频消融术后联合肝动脉化疗栓塞是治疗肝癌的有效方法。 相似文献
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目的:研究并探讨经肝动脉化疗栓塞(TACE)联合微波消融(MWA)治疗大肝癌(含巨块型肝癌)1年内局部复发的影响因素。方法:回顾性分析2013年1月至2016年6月151例行TACE联合WMA治疗的初治大肝癌患者为研究对象,收集患者治疗前后住院资料及随访资料,通过单因素分析及Logistic 回归分析探求TACE联合MWA治疗大肝癌1年内局部复发的影响因素。结果:151例患者平均行TACE治疗(1.48±0.43)次、WMA治疗 (1.23±0.16)次;联合治疗1个月后,客观缓解率(ORR) 、疾病控制率(DCR)分别为80.8%、92.7%;治疗1年内局部复发率为45.7%;复发组与未复发组在瘤体最大直径、合并门静脉癌栓(PVTT)、肝门淋巴结转移、术前甲胎蛋白(AFP)水平、毗邻危险区域、病毒载量、靶向治疗7方面差异显著(P<0.05)。多因素分析显示:瘤体最大直径(OR7.5~10 cm=3.935;OR>10 cm=6.379)、术前合并门静脉癌栓(OR=7.877)、术前AFP≥400 ng/ml(OR=3.411)是TACE联合WMA治疗大肝癌术后1年内复发的独立危险因素(P均<0.05),术后服用索拉菲尼则是复发的独立保护因素(OR=0.119)(P<0.05)。结论:术前AFP≥400 ng/ml、瘤体最大直径超过7.5 cm、合并门静脉癌栓是TACE联合WMA治疗大肝癌短期内复发的预测因子,而术后联合靶向治疗有助于降低短期复发率。 相似文献
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目的:分析射频消融联合肝动脉化疗栓塞对原发性肝癌基因表达及生存期的影响。方法:选择2013年1月至2014年6月在我院接受治疗的原发性肝癌患者90例作为研究对象,根据随机数表法将所选对象分为观察组和对照组,每组均为45例。观察组患者给予射频消融联合肝动脉化疗栓塞,对照组给予单独肝动脉化疗栓塞。观察两组患者治疗后近期疗效、肿瘤坏死情况、远期疗效、肝癌组织中促凋亡基因以及凋亡抑制基因情况。结果:观察组患者治疗后近期疗效(84.44%)优于对照组患者(46.67%),比较差异有统计学意义(P<0.05);观察组肿瘤完全坏死率(86.67%)高于对照组(26.67%),观察组肿瘤不完全坏死率和部分坏死率(8.89%、4.44%)低于对照组(31.11%、42.22%),比较差异有统计学意义(P<0.05);观察组和对照组治疗后1年生存率差异无统计学意义(P>0.05);观察组治疗后2、3年生存率(66.67%、53.33%)显著高于对照组(42.22%、26.67%),比较差异具有统计学意义(P<0.05);观察组治疗后肝癌组织中促凋亡基因MTS1、Caspase-3及 Bax的mRNA含量(213.08±27.86、226.89±31.54、249.42±31.51)均显著高于对照组(100.09±11.74、100.13±14.25、101.38±14.65),比较差异有统计学意义(P<0.05);观察组肝癌组织中凋亡抑制基因PLK1、Bcl-2及Survivin的mRNA含量(21.46±3.43、33.41±5.07、29.02±3.85)均低于对照组(101.52±11.82、100.73±14.16、100.49±17.63),比较差异有统计学意义(P<0.05)。结论:射频消融联合肝动脉化疗栓塞治疗原发性肝癌患者的近远期疗效显著,可提高肿瘤坏死率,促进肝癌细胞凋亡,延长患者生存期。 相似文献
18.
《International journal of hyperthermia》2013,29(6):555-562
Objective: To evaluate the efficiency and feasibility of contrast-enhanced ultrasound (CEUS)-guided microwave ablation for hepatocellular carcinoma inconspicuous on conventional US.Materials and methods: From March 2006 to February 2010, 107 patients (93 male, 14 female; mean age 58.9?±?11.0 years) with 107 hepatocellular carcinoma (HCC) nodules (mean maximum diameter 19.5?±?8.5?mm) inconspicuous on conventional US underwent microwave (MW) ablation under CEUS guidance in this study. US contrast agent was SonoVue (Bracco, Milan, Italy), a second-generation contrast agent. CEUS was performed first, and then MW ablation was carried out by means of CEUS guidance under unconscious intravenous anaesthesia if the tumours were displayed on CEUS.Results: 105 tumours were successfully visualised on CEUS by using 1–2 times contrast agent injection and MW ablation was performed under CEUS guidance. The technical success rate was 98.13% (105/107). The number of antenna insertions for each tumour was 1.89?±?0.92, and the mean session of MW ablation for each tumour was 1.08?±?0.28. The mean duration of energy application for each tumour was 7.05?±?4.03?min. The follow-up time was 12–54 months (median 18 months). The technique effectiveness rate was 99.05% (104/105). The local tumour progression rate was 1.9% (2/105). There were no severe complications in any patients.Conclusion: CEUS-guided MW ablation is an efficient and feasible treatment method for patients with hepatocellular carcinoma inconspicuous on conventional US. 相似文献
19.
肝动脉栓塞化疗后射频消融联合酒精消融对原发性肝癌的疗效评价 总被引:21,自引:0,他引:21
目的 探讨肝动脉栓塞化疗(TACE)后,CT导向下射频消融(RFA)联合无水乙醇消融(PEI)对原发性肝癌(HCC)的治疗效果。方法 经病理、AFP或典型影像学诊断证实的HCC 1 5 0例,每例肝内的病灶数目<3个,病灶大小3.1~7.9cm ,平均直径5 .5cm。全部患者按就诊单双日分为对照组和联合组。对照组74例,TACE后2周行单纯RFA ;联合组76例,TACE后2周行射频消融,间隔2 0~30d后再行PEI。结果 对照组的完全坏死率为75 .8%,联合组为89.5 %,两组间差异有统计学意义(P <0 .0 5 )。结论 HCC患者经TACE后,行CT导向下RFA联合PEI的疗效明显优于单纯RFA。 相似文献
20.
《International journal of hyperthermia》2013,29(5):448-455
Purpose: To compare the effectiveness of ultrasound (US)-guided percutaneous 915 MHz microwave (MW) ablation with the 2450 MHz MW ablation for large hepatocellular carcinoma (HCC) (>4 cm in diameter).Materials and methods: Patients with HCC >4 cm in diameter who underwent US-guided percutaneous MW ablation with curative intention between March 2007 and December 2008 (39) were randomly divided into two groups, 915 MHz MW group and 2450 MHz MW group. We compared the results of ablation between the two groups.Results: Fewer antenna insertions for each tumour were required in the 915 MHz MW group (3.69 ± 0.6) than in the 2450 MHz MW group (4.71 ± 1.61) (p = 0.01). According to the follow-up contrast-enhanced imagings, technique effectiveness rate was 85.7% (18/21) and 73.7% (14/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). The rate of local tumour progression (LTP) was 14.3% (3/21) and 26.3% (5/19) in the 915 MHz MW group and 2450 MHz MW group, respectively (p = 0.44). There were no deaths and no thrombosis of major vessels in any patient.Conclusions: Compared with 2450 MHz MW ablation, our initial experience showed that percutaneous 915 MHz MW ablation with cooled-shaft antennae was safe and could achieve a high technique effectiveness rate with fewer insertion numbers in the treatment of large HCC. Therefore, percutaneous 915 MHz MW ablation may provide a new method for the treatment of large HCC. 相似文献