TACE联合CT引导下微波消融治疗肝细胞肝癌的临床应用

目的：探讨经肝动脉化疗栓塞术（TACE）联合CT引导下微波消融治疗肝细胞肝癌的临床疗效。 方法：选择通过临床诊断证实的肝细胞肝癌患者45例，行TACE治疗后序贯给予CT引导下的病灶局部微波消融治疗，检测患者治疗后3、6、12、24个月的血液甲胎蛋白（AFP）水平变化情况，分析总结术后不同时间的肿瘤局部控制情况和患者生存率。 结果：45例肝细胞肝癌患者术后3、6、12、24个月血AFP下降有效率为100%（45/45）、100%（45/45）、93.3%（42/45）、91.1%（41/45）；病灶局部控制率依次为：100%（45/45）、100%（45/45）、97.8%（44/45）、88.8%（40/45）；生存率分别为：100%（45/45）、100%（45/45）、93.3%（42/45）、91.1%（41/45）。TACE治疗后患者出现发热、疼痛、均出现食欲下降、呕吐、肝功能异常等表现，对症处理后基本恢复。微波消融后患者有2例患者术后出现胸腔积液，经对症处理后积液消失。45例患者均未发生治疗相关性死亡病例。 结论：TACE联合CT引导下微波消融治疗肝细胞肝癌，CT下定位精确，显像明显，治疗效果较佳，是提高肿瘤局部控制率并延长患者生存期的有效方法。

Clinical application of TACE combined with CT guided microwave ablation in treatment for hepatocellular carcinoma

Objective:To explore the clinical efficacy of transcatheter arterial chemoembolization, (TACE) combined with CT guided microwave ablation in the treatment of hepatocellular carcinoma. Methods:The patients (45 cases) with hepatocellular carcinoma confirmed by clinical treatment were treated with local microwave ablation with CT guidance after TACE treatment. The changes of alpha fetoprotein (AFP) , local control of tumor and survival rate of the patients were analyzed at 3, 6, 12 and 24 months after treatment. Results:The decrease rates of AFP in 3, 6, 12 and 24 months after operation were 100% (45/45) , 100% (45/45) , 93.3% (42/45) and 91.1% (41/45) , the rates of local control were 100% (45/45) , 100% (45/45) , 97.8% (44/45) and 88.8% (40/45) , and the survival rates were 100% (45/45) , 100% (45/45) , 93.3% (42/45) and 91.1% (41/45) , respectively. TACE treatment showed side effects such as fever, pain, loss of appetite, vomiting and abnormal liver function, and the patients recovered after symptomatic treatment. After microwave ablation, 2 patients had pleural effusion after operation, and the effusion disappeared after symptomatic treatment. No treatment-related death occurred in 45 patients. Conclusions:TACE combined with CT guided microwave ablation could be used in the treatment of hepatocellular carcinoma, the location of CT is accurate, the imaging is obvious, the therapeutic effect is better, and the local control rate of tumor and the effective method of prolonging the life period of the patients are improved.