射频消融联合肝动脉栓塞化疗治疗难以手术切除的原发性肝癌

目的:探讨经皮射频消融(RFA)联合肝动脉栓塞化疗术(TACE)在难以手术切除的原发性肝癌治疗中的价值。方法:55例原发性肝癌患者,30例行单纯TACE治疗,25例行RFA联合TACE治疗,治疗后定期复查B超、CT或MRI,确定肿瘤坏死范围,应用流式细胞术检测治疗前和治疗后4周两组外周血CD4+、CD8+、CD4+/CD8+的变化,采用酶联免疫吸附分析法(ELISA)检测治疗后12周患者血清甲胎蛋白(AFP)的情况,Kaplan-Meier法计算预期生存率并预测平均生存期。结果:TACE组治疗前CD4+为28.68%±7.58%,治疗后为30.16%±6.33%,二者之间差异无显著性意义(P>0.05)。TACE组CD8+、CD4+/CD8+治疗前后均无显著性差异(P>0.05)。综合组治疗后CD4+、CD4+/CD8+明显高于治疗前(P<0.05)。综合组治疗后CD8+显著低于治疗前(P<0.05)。TACE组与综合组术后肿瘤坏死范围分别为(0.25±0.07)cm和(2.01±0.26)cm,二者之间差异有显著性(P<0.01)。综合组术后血清AFP含量为(32.77±4.66)μg·L-1,与TACE组术后血清AFP含量(256.33±17.85)μg·L-1相比差异有显著性意义(P<0.01)。综合组术后平均生存时间明显长于TACE组(P<0.01)。结论:对于难以手术切除的原发性肝癌,经皮射频消融联合肝动脉栓塞化疗可明显改善患者免疫功能,提高临床疗效。

Treatment of Unresectable Primary Hepatocellular Carcinoma by Percutaneous Radiofrequency Ablation Combined with Transcatheter Hepatic Arterial Chemoembolization

Objective: To investigate the clinical value of percutaneous radiofrequ ency ablation combined with transcatheter hepatic arterial chemoembolization (TA CE) for treating unresectable primary hepatocellular carcinoma. Methods : 55 patients with primary hepatocellular carcinoma were involved in th e study. 30 patients were treated with TACE only, and the other 25 patients were performed with the combination of radiofrequency ablation and TACE. After the t reatments, ultrasonography, CT and MRI were introduced to observe the range of t umor necrosis. Flow cytometry was used to measure the changes of CD4~+、CD8~+ and CD4~+/CD8~+ in peripheral blood before and after the operation. AFP levels were also detected by enzymelinked immunosorbent assay and were compared befo re and after the treatment. KaplanMeier survival analysis was used to calculat e the survival rate and forecast the mean survival time. Results: The values of CD4~+ were 28.68%±7.58% before operation versus 30.16%±6.33% ~ after operation in TACE group without significant difference (P>0.05 ). And there were no significant differences between before and after operation in CD8~+ and CD4~+/CD8~+ (P>0.05). However, in the combination group, the values of CD4~+ and CD4~+/CD8~+ after operation were significantly highe r than those before operation (P<0.05), and the value of CD8~+ after operat ion was significantly lower than that before operation (P<0.05). In addition , the range of tumor necrosis in the combination group\(2.01±0.26)cm\] was obv iously bigger than that in the TACE group\(0.25±0.07)cm\] (P<0.01), and th e content of AFP in combination group\(32.77±4.66) μg·L~-1\]was signifi cantly lower than in the TACE group\(256.33±17.85) μg·L~-1\] (P<0.0 5). The mean survival time in the combination group was remarkably longer than i n the TACE group (P<0.01). Conclusion: For unresectabl e primary hepatocellular carcinoma, the combination of percutaneous radiofrequen cy ablation and transcatheter hepatic arterial chemoembolization can strikingly improve immune function of patients and increase clinical effects of treatment.