经肝动脉化疗栓塞-冷循环微波刀序贯治疗老年肝癌患者的疗效分析

目的探讨经肝动脉化疗栓塞-冷循环微波刀序贯治疗（TACE-PPMCT）老年肝癌患者的疗效。方法对44例60岁以上原发肝癌患者（原发灶44个伴16个转移灶）行TACE1周后,在CT引导下行PPMCT,术后1个月行CT增强和DSA造影。观察术中、术后并发症的发生情况,比较治疗前后肿瘤直径的变化、AFP水平变化;术后随访6～18个月。结果除1例患者术中出现窦性心动过缓外,未见其他术中及术后并发症。术后1个月44个原发灶中36个完全坏死（81.82%）,6个不完全坏死（13.64%）,2个部分坏死（4.54%）;16个转移灶中12个完全坏死（75.00%）。术前AFP升高的32例患者中30例术后AFP下降,其中22例降至正常;另2例术后AFP升高。随访6～18个月,生存44例,复发转移8例,其中6例为术后12个月内出现。结论 TACE-PPMCT治疗老年原发性肝癌创伤小、并发症少、安全,疗效可靠。

Therapeutic effect of transcatheter arterial chemoembolization combined with psychro-circulation percutaneous microwave coagulation therapy for aged patients with hepatocellular carcinoma

Objective To evaluate the therapeutic effect of transcatheter arterial chemoembolization (TACE) combined with psychro-circulation percutaneous microwave coagulation therapy (PPMCT) in the treatment of aged patients with hepatocellular carcinoma. Methods Forty-four patients with hepatocellular carcinoma above 60 years old underwent CT-guided PPMCT 1 week after TACE. Digital subtraction angiography (DSA) and enhanced CT were performed after 1 month. The complications during and after operation were observed. The alphafetoprotein (AFP) levels and the diameters of the tumors were measured and compared. The postoperative follow-up period varied from 6 to 18 months. Results No other complications were found except for intraoperative sinus bradycardia occurred in 1 case. One month after the therapy, the primary lesions disappeared completely in 36 (81.82%), incomplete necrosis occurred in 6 (13.64%)and partial necrosis was found in 2 patients (4.54%). Complete necrosis was found in 12 of 16 metastases. AFP levels decreased in 30 of 32 patients with preoperative abnormal AFP, and in 22 among them decreased to normal range, but increased in the other 2 patients. The survival rate was 100% during the follow-up period, but recurrence and metastasis were found in 8 patients, and 6 of them were found within 12 months after the treatment. Conclusion The sequential TACE-PPMCT is a micro-invasive and safe method with less complications and reliable effect for treatment of primary hepatocellular carcinoma in aged patients.