ＴＡＣＥ联合热疗治疗原发性肝癌的临床观察

目的　观察肝动脉化疗栓塞（ＴＡＣＥ）联合局部高频热疗治疗原发性肝癌的临床疗效和毒副反应，以及血清ＶＥＧＦ、ＴＮＦ-和ＳＩＬ-Ｒ的变化。方法　２００９年１月至２０１０年１２月间收治６０例原发性肝癌患者，随机分为单纯ＴＡＣＥ组（Ａ组）和ＴＡＣＥ联合热疗组（Ｂ组）。Ａ、Ｂ两组均在ＤＳＡ下对肿瘤病灶进行ＴＡＣＥ治疗，其中Ｂ组栓塞后保留导管，持续灌注化疗药物，同时对局部进行高频热疗。观察两组的临床疗效和毒副反应，并分别检测各组治疗前、治疗后１周和治疗后１个月血清ＶＥＧＦ、ＴＮＦ-、ＳＩＬ-Ｒ水平的变化。结果　Ａ组有效率（ＲＲ）为３６.％，Ｂ组为６０.％；Ａ组卡氏评分改善率为３３.％，Ｂ组为７３.％；Ａ组疼痛缓解率为３８.5，Ｂ组为８３.％。两组均出现１～２级恶心、呕吐、脱发、低热及轻度肝功能损害。治疗后１周和治疗前比较，两组血清ＶＥＧＦ均有不同程度的升高，Ｂ组升高明显（Ｐ＜０.05）；治疗１个月后较治疗前，两组均有下降，但Ｂ组下降明显（Ｐ＜０.０５）。治疗后１周两组血清ＴＮＦ-α、ＳＩＬ-２Ｒ水平较术前下降，Ｂ组下降明显（Ｐ＜０.０５）；治疗后１个月与治疗后１周比较，Ａ组升高（Ｐ＜０.０５），Ｂ组继续下降（Ｐ＜０.０５）。结论　ＴＡＣＥ联合局部高频热疗治疗原发性肝癌可以增加治疗的有效率并缓解疼痛，提高患者的生活质量，且血清ＶＥＧＦ、ＴＮＦ-α、ＳＩＬ-２Ｒ水平存在明显的动态变化，是治疗原发性肝癌的一种安全、有效的方法。

Clinical observation of TACE combined with high-frequency thermotherapy for primary liver carcinoma

Objective To observe curative effect and side effects,and detect the changes of VEGF,TNF-α and SIL-2R in serum of primary liver carcinoma patients treated with TACE and local high-frequency thermotherapy.Methods From Junuary 2009 to December 2010,60 primary liver carcinoma patients were selected and divided into 2 groups randomly： group A was taken TACE alone,group B was underwent TACE combined with high-frequency thermotherapy.Results The response rate of A and B groups was 36.7% and 60.0%;Karnofsky score improvement rate was 33.3% and 73.3%;pain relief rate was 38.5% and 83.3%.The side effects were grade 1-2 nausea,vomiting,alopecia,low fever and mild liver function injury.After a week treatment,the serum level of VEGF increased in two groups,but there was a significant difference in group B（P0.05）;after one month treatment,VEGF decreased in two groups,but there was a significant difference in group B（P0.05）.After a week treatment,the level of serum TNF-α and SIL-2R decreased in two groups,and there were significant differences in group B（P0.05）;after one month treatment,there were significantly discrepancies in two groups（P0.05）.Conclusion In the left hepatic artery after embolization chemotherapy combined with local high frequency hyperthermia pipe treatment of primary liver cancer,after treatment,levels of serum VEGF,TNF-α,SIL-2R change obviously;and it may increase the treatment efficiency,ease pain and improve the quality of life of patients,thus prolonging survival of patients,which is a safe and effective method in the treatment of primary liver cancer.