氩氦刀联合肝动脉化疗栓塞治疗肝癌（附388例病例分析）

目的 探讨氩氦刀冷冻消融联合肝动脉插管化疗栓塞（transcatheter hepatic arterial chemoembolization,TACE）治疗肝癌的疗效及其影响因素.方法 自2000年8月至2008年4月,388例肝癌患者接受了氩氦刀治疗,平均年龄为（53.6±12.9）岁,超声引导经皮穿刺完成353例;CT引导经皮穿刺完成35例.氩氦刀后TACE治疗1次者77例;治疗2次者143例;治疗3次或3次以上者168例.结果 388例肝癌患者成功完成了氩氦刀治疗,完全消融者119例;部分消融者269例;生存率分析显示：氩氦刀＋TACE治疗的1、2、3和5年总生存率分别为70.4%、52.3%、23.5%和7.5%;对于肿瘤最大直径为3.0～5.0 cm、5.1～10 cm或〉10.0 cm的患者,3年生存率分别为36.9%、24.9%和3.2%;氩氦刀完全消融和部分消融的患者3年存活率分别为67.2%和4.1%.用COX回归作变量筛选,肿瘤大小、肝功能分级、有无肝硬化对其生存率具有较大影响,P〈0.05.结论 对于不能手术切除的肝癌,氩氦刀＋TACE是较理想的选择,治疗效果较好,安全性高.肿瘤大小、有无肝硬化、乙型肝炎表面抗原是否阳性以及肝功能状况对治疗效果有明显影响.

Efficacy of cryoablation combined with transarterial chemoembolization for unresectable liver cancer and prognostic factors

Objective To investigate the effects of the combined transarterial hepatic arterial chemoembolization （TACE） with cryoablation for unreseetable liver cancer and its influence factors. Methods During August 2000 to April 2008, 388 patients with liver cancer underwent cryoablation plus TACE. All patients with a median age of （53. 6± 12. 9） years were deemed to have unresectable liver cancer based on their tumor characteristics. Cryoablation was performed percutaneously under ul- trasound in 335 cases, and CT in 53 cases. Seventy-seven cases were given TACE once after cryoabla- tion, 143 cases twice and 159 cases 3 thrice or more. Results Technical success of cryoablation was a- chieved in 388 patients. Complete ablation was ] 19 cases, and partial ablation 269 cases. Life analysis showed 1-, 2-, 3- and 5-survival rate fro eryoablation combined with TACE was 70. 4%, 52. 3%, 23.5 % and 7. 5 % respectively. The 3-year survival rate in patients with maximum tumor diameter, of 3.0-5.0 cm, 5.1-10 cm or 〉10. 0 cm was 36. 9%,24. 9% and 3.2% respectively. The 3-year survival rate in patients receiving complete or partial ablation who accepted treatment of cryoablation was 67. 2% and 4. 1% respectively. The Cox regression model revealed that the tumor size, liver cirrhosis and liver function were significant variables influencing survival time （P〈0. 05）. Conclusion It is an ideal means for unresectable liver cancer of cryoablation combined with TACE, which is good and safe. Tumor size, liver cirrhosis, positive HBsAg and grade of liver function have obvious impact on the treatment effectiveness.