肝动脉栓塞化疗联合CT引导精准微波消融治疗原发性肝癌患者疗效及对外周血T淋巴细胞亚群的影响

目的 探讨肝动脉栓塞化疗（TACE）联合CT引导精准微波消融治疗原发性肝癌患者的疗效及对外周血淋巴细胞亚群的的影响。方法 2010年1月~2014年12月新疆维吾尔自治区阿克苏地区第一人民医院肿瘤内科收治的原发性肝癌患者60例,对30例患者行TACE治疗,另30例在行TACE治疗后7天接受CT引导下精准微波消融术。采用酶联免疫吸附法测定血清α-L-岩藻糖苷酶水平,使用流式细胞仪检测外周血T淋巴细胞亚群水平。结果 在治疗3个月后,TACE治疗患者临床有效率为50%（15/30）,显著低于联合治疗组患者的83.3%（25/30,P<0.05）;联合治疗患者2 a生存率为70.0%,显著高于TACE治疗组的43.3% （P<0.05）;联合治疗患者2 a复发率为10%,显著低于TACE的36.7%（P<0.05）;治疗后,联合组外周血CD4⁺、CD8⁺、CD4⁺/CD8⁺比值、血清α-L-岩藻糖苷酶水平分别为（39.05±4.07）%、（21.35±3.24）%、（1.67±0.21）、（17.91±2.98） u/L,较TACE组的（28.63±3.61）%、（35.12±4.62）%、（0.96±0.11）、（26.03±4.75） u/L改善更明显（P<0.05）;治疗期间,两组患者均在TACE术后出现一些轻症反应,如腰酸、腹胀、恶心等,予以对症治疗及护理后均消失。结论 TACE联合CT引导下经皮精准微波消融治疗原发性肝癌患者临床效果确切。与单用TACE治疗比,可提高长期生存率,降低复发率,纠正机体免疫功能紊乱。

Clinical effect of transcatheter hepatic arterial chemoembolization combined with CT-guided precision microwave ablation on patients with primary liver cancer

Objective To investigate the clinical effect of transcatheter hepatic arterial chemoembolization (TACE) combined with CT-guided precision microwave ablation on patients with primary liver cancer and its influence on immune founction. Methods 60 patients with primary liver cancer including 42 men and 18 women admitted to our hospital between January 2010 and December 2014,and they were divided into control and observation group with 30 cases in each group according to the hospitalization order. Patients in control group were treated with TACE,and in observation group received TACE combined with CT-guided precision microwave ablation. The clinical effect,2 annual survival rate,the relapse rates and the subsets of T-lymphocytes and serum alpha-L-fucosidase levels were compared between the two groups. Results At the end of three month therapy,the clinical effect in observation group was 83.3%（25/30）,significantly higher than 50%（15/30） in the control group （P<0.05）;the two annual survival rate in the observation group was 70.0%,much higher than 43.3% in the control group（P<0.05）;the relapse rate in the observation group was 10.0%, significantly lower than 36.7% in the control （P<0.05）;After therapy,the percentage of CD4⁺T-lymphocytes,CD8⁺T-lymphocytes, the ratio of CD4⁺/CD8⁺,serum alpha-L-fucosidase levels in the observation group was（39.05±4.07）%,（21.35±3.24）%,（1.67±0.21）,（17.91±2.98） u/L,markedly improved as compared to those in the control group[（28.63±3.61）%,（35.12±4.62）5,（0.96±0.11）,（26.03±4.75）u/L,respectively,P<0.05];Additionally,all patients appeared some mild reactions after TACE,such as backache,abdominal distension,nausea,etc,and they disappeared after symptomatic treatment and nursing. The adverse reactions between the two groups showed no statistically difference. Conclusion Transcatheter hepatic arterial chemoembolization combined with CT-guided precision microwave ablation have definite curative effect on patients with primary liver cancer,which could improve the survival rate,and decrease relapse rate.