超声引导微波联合肝动脉化疗栓塞术治疗大肝癌的疗效评价

目的探讨超声引导微波联合肝动脉化疗栓塞术(transarterial chemoembolization,TACE)治疗大肝癌的疗效.方法 35例大肝癌采用超声引导微波联合TACE介入治疗(微波联合TACE组),并选择同期40例大肝癌采用单纯微波治疗(单纯微波治疗组)和31例采用单纯TACE治疗(单纯TACE治疗组)作为对照. 结果微波联合TACE治疗后30例AFP降至正常,3例明显下降;超声检查:80.0%(28/35)肿块缩小 ,20.0%(7/35)无变化, 肿块中心回声增强 , 周边呈低回声, 境界清晰, 其中可见钙化回声, 肿瘤内血流消失或减少.12例超声引导下活检,病理组织学结果显示: 肿瘤完全坏死9例,不完全坏死3例.30例CT检查, 76.7%(23/30)肿块缩小.微波联合TACE组缓解率(CR PR)88.6%(31/35),1、2、3、5年生存率分别为88.6%(31/35)、71.4%(25/35)、60.0%(21/35)、42.9%(15/35),均高于单纯微波组及单纯TACE组.无严重并发症发生. 结论超声引导微波联合TACE介入治疗大肝癌安全、有效、实用, 比单纯微波或TACE治疗效果好,为不能手术切除或其它治疗效果不佳的大肝癌提供了一种可行和有效的治疗方法.

Evaluation of ultrasound-guided microwave coagulation in combination with transarterial chemoembolization for large hepatic cancers

Objective To discuss the effectiveness of ultrasound-guided microwave coagulation combined with transarterial chemoembolization (TACE) in the management of large hepatic cancers. Methods A total of 35 patients with large hepatic cancer received ultrasound-guided microwave coagulation combined with TACE (Combination Group), while, served as control groups, 40 patients with the same diagnosis from the same period underwent only ultrasound-guided microwave coagulation (Microwave Group) and 31 patients underwent only TACE (TACE Group). Results In the Combination Group the serum AFP level dropped to normal limits in 30 patients and decreased obviously in 3 patients. Ultrasonography showed that lesions had decreased in size in 80.0% of the patients (28/35) and had not changed in 20.0% of the patients (7/35). Hyperechoic status was found in the central part of the lesions, and the outer part of the lesions was hypoechoic, with clear border. Calcification echo, with disappeared or decreased blood flow signals, was detected inside the lesions. Pathological examinations from ultrasound-guided biopsy in 12 patients revealed complete necrosis of lesions in 9 patients and partial necrosis in 3 patients. CT scans in 30 patients showed lesions decreased in size in 76.7% of the patients (23/30) .In the Combination Group, the remission rate (CR+PR) was 88 6% (31/35), and the 1-, 2-, 3-, and 5-year survival rates were 88 6% (31/35), 71 4% (25/35), 60 0% (21/35), and 42 9% (15/35), respectively, all of which were higher than those in the Microwave Group or in the TACE Group. In the study no severe complications occurred. Conclusions Combination application of ultrasound-guided microwave coagulation and TACE is safe, effective and practical, superior to microwave therapy or TACE. It is an effective and practical way for large hepatic cancers inoperable or unresponsive to other measures.