肝动脉化疗栓塞联合射频消融术治疗30例原发性大肝癌的疗效评价

目的探讨肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗原发性大肝癌(病灶平均长径7.9 cm)的疗效。方法自2009年8月至2010年9月,对在新疆医科大学附属肿瘤医院治疗的30例原发性肝细胞大肝癌的患者的41个病灶,先行TACE治疗2～3次,2～4周后行RFA 1～3次。术后随访临床症状、B超造影或CT扫描的肿瘤大小、肝功能、AFP以及生存期。结果 30例患者术后临床症状均较术前缓解。术后CT复查显示:18个(43.9%)肿瘤病灶完全坏死,内部及边缘无明显强化;23个(56.1%)肿瘤病灶部分坏死。AFP下降25例(83.3%)、不变2例(6.7%),升高3例(10.0%)。并发症中1例出现表皮灼伤,2例顽固性呃逆,3例肝内出血,1例肝脓肿,4例术后出现严重低蛋白血症。所有病例随访4.1～20.1个月,中位生存期为8.1个月,平均生存期11.1个月。结论肝动脉化疗栓塞联合RFA是治疗不可切除的原发性大肝癌的有效方法,确切结论仍需要大样本的随机对照临床研究进一步证实。

TACE combined with radiofrequency ablation for massive primary hepatocellular carcinomas: a clinical therapeutic evaluation

Objective To discuss the therapeutic efficacy of transcatheter arterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) for massive hepatocellular carcinomas.Methods During the period from August 2009 to September 2010,a total of 30 patients with large hepatocellular carcinoma(at least one lesion with the diameter over 5 mm) were treated with TACE in combination with RFA.After the procedure,all patients were followed-up for 4-20 months.The outcomes were evaluated by the clinical relief of symptoms,the tumor’s size determined on B-sonograph or CT scanning,hepatic function,alpha fetoprotein(AFP) levels,the occurrence of procedure-related complications and survival time.A p-value of less than 0.05 was considered to indicate a significant difference.Results The whole procedure was successfully performed in all 30 patients.After the treatment,the symptoms were relived and the clinical conditions were improved in all patients.Follow-up CT scanning showed that complete necrosis was seen in 43.90% of lesions(18/41),and partial necrosis was detected in 56.10% of lesions(23/41).The AFP level decreased in 83.33% of patients(25/30),increased in 10% of patients(3/30) and was unchanged in 2 cases(6.67%).The complications included epidermal burn(n = 1),refractory hiccup(n = 2),intra-hepatic bleeding(n = 3),liver abscess(n = 1) and severe postoperative hypoproteinemia(n = 4).The median survival period was 8.1 months and the mean survival period was 11.1 months.Conclusion TACE together with RFA is an effective treatment for inoperable large hepatocellular carcinomas.However,the clinical long-term efficacy needs to be clarified by further follow-up observation and random control trials with large sample.