TACE序贯MWA或RFA治疗原发性肝癌的疗效及安全性比较

目的:比较经导管肝动脉化疗栓塞（TACE）序贯微波消融术（MWA）或射频消融术（RFA）治疗原发性肝癌的疗效及安全性。方法:回顾性分析武汉协和医院接受治疗的原发性肝癌患者70例，将其分为TACE+MWA组36例与TACE+RFA组34例，比较两组临床疗效、生存率、肿瘤体积、血供消失率、完全坏死率、甲胎蛋白（AFP）水平、丙氨酸氨基转移酶（ALT）水平、天门冬氨酸氨基转移酶（AST）水平以及不良反应发生率。结果:TACE+MWA组疾病控制率（91.67%）与TACE+RFA组（88.24%）比较差异无统计学意义(P＞0.05)；两组肿瘤体积、血供消失率、完全坏死率比较差异无统计学意义(P＞0.05)；治疗后两组AFP水平与治疗前比较均明显降低(P＜0.05)，组间比较差异无统计学意义(P＞0.05)，治疗后两组ALT、AST水平与治疗前比较均明显升高(P＜0.05)，且组间比较差异具有统计学意义(P＜0.05)；两组6个月、1年、3年生存率比较差异无统计学意义(P＞0.05)。结论:TACE序贯MWA或RFA治疗原发性肝癌，疾病控制率、生存率、血供消失率与完全坏死率等无明显差异，均能有效控制肿瘤发展，促进AFP、ALT、AST等因子水平恢复至正常范围，延长生存期，且安全性尚可，临床可替换使用，但TACE+MWA组治疗后应注意加强保肝治疗。

The comparison on efficacy and safety of TACE sequential MWA or RFA in the treatment of primary liver cancer

Objective:To compare the efficacy and safety of transcatheter arterial chemoembolization（TACE) sequential microwave ablation（MWA) or radiofrequency ablation（RFA) in the treatment of primary liver cancer.Methods:70 patients with primary liver cancer patients treated in our hospital were retrospectively analyzed,and they were divided into TACE+MWA group（36 cases) and TACE+RFA group（34 cases).The clinical efficacy,survival rate,tumor volume,blood supply disappearance rate,total necrosis rate,alpha fetoprotein（AFP) level,alanine aminotransferase（ALT) level,aspartate aminotransferase（AST) level,and the incidence rate of adverse reaction were compared in the two groups.Results:There was no significant difference in disease control rate between TACE+MWA group（91.67%) with TACE+RFA group（88.24%)（P＞0.05).There was no significant difference in tumor volume,blood supply disappearance rate and complete necrosis rate between the two groups（P＞0.05).AFP levels in the two groups were significantly lower than those before treatment（P＜0.05).And there was no significant difference between the two groups（P>0.05).After treatment,the levels of ALT and AST in the two groups were significantly higher than those before treatment（P＜0.05),and the difference between the two groups was statistically significant（P＜0.05).There was no significant difference in the survival rate between the two groups at 6 months,1 year and 3 years（P＞0.05).Conclusion:There was no significant difference in disease control rate,survival rate,blood supply disappearance rate and complete necrosis rate between TACE sequential MWA or RFA treatment of primary liver cancer.They can effectively control the development of tumor,promote the levels of AFP,ALT,AST and other factors to return to normal range,prolong the survival time,and the have available safety.However,TACE+MWA group should pay attention to strengthening liver protection treatment after treatment.