氩氦冷冻在原发巨块型肝癌介入治疗中的临床应用

目的 探讨肝动脉化疗栓塞(TACE)后，应用氩氦冷冻(AHCS)治疗原发性巨块型肝癌的新方法。方法 48例原发性肝癌，肿瘤直径10-14cm，均为富血供。肝功能Child A级38例，Child B级10例。甲胎蛋白阳性40例，阴性8例。随机分组，治疗组26例，对照组22例。治疗组病例均在TACE后4周实施AHCS治疗。各组术后行病理学、肝功能、肿瘤标记物、T淋巴细胞亚群分布，CT或MRI、超声检查。计算肿瘤坏死率采用Cavalieri方法；评价疼痛、生活质量分别采用数字分级法(NRS)和EORTCQLQ．C30方法。结果 技术成功率达100％。术后随访6～14个月，随访率100％。肿瘤平均坏死率TACE为8．07％，AHCS为28．65％。与TACE比较，AHCS后肿瘤标记物下降幅度较大，坏死较为明显。肝功能：与TACE术前比较，TACE术后损害程度较重，持续时间(2周)较长，与TACE比较，AHCS损害轻微，持续时间(1周)较短。T淋巴细胞亚群分布：与。TACE前比较，TACE后细胞免疫功能低下表现更为明显。AHCS后，T淋巴细胞亚群异常分布得到纠正。AHCS术后48h，局部疼痛是惟一较TACE重的副反应。结论 对于巨块型肝癌，TACE与AHCS具有治疗协同和优势互补作用，有利于短期内降低肿瘤负荷，近期疗效满意；TACE是抑制肿瘤血管“热池效应”，提高AHCS治疗效果的关键；AHCS术后能提高细胞免疫功能，有利于改善肝功能状况，相对提高了患者的生活质量。

Clinical application of Argon-Helium cryotherapy system in the treatment of hepatocellular carcinoma

Objective To explore the efficacy of Argon-Helium cryotherapy system (AHCS) after transarterial chemoembolization (TACE) in treating the large hepatocellular carcinoma (HCC) with diameter over 10 cm. Methods Forty-eight HCC patients were randomly divided into therapy group (n=26) and control group (n=22), and patients in the therapy group were treated with AHCS (Cryocare~TM Surgical System) 4 weeks after TACE. Tumor size ranged from 10 to 13 cm. All tumors were hypervascular with Child A in 38 cases and Child B in 10 cases. AFP was positive in 40 cases and negative in 8. Reexamination included pathology, tumor marker, T-lymphocyte subgroup, ultrasound, CT, or MRI. Necrosis rate was calculated with Cavalieri theory. Numerical rating scale (NRS) for pain evaluation and EORTC QLQ-C30 for life quality evaluation were performed. Results Technical success rate was 100%. Follow-up time varied from 6 to 14 months, and follow-up rate was 100%. Average neoplasm necrosis rate was 8.07% after TACE, and 28.65% after AHCS. Tumor marker significantly deceased after AHCS. The necrosis after AHCS was more significant than that after TACE alone. AST and ALT deteriorated for 2 weeks after TACE and for 1 week after AHCS. Local pain 48 hours after AHCS was the only more serious side effect than after TACE. Immunological function was significantly suppressed after TACE. CD_3+, CD_4+, and NK increased after AHCS, and abnormal distribution was corrected. Coagulative necrosis was founded in the tumor target area pathologically. Quality of life increased according EORTC QLQ-C30 results after AHCS. No severe complication occurred. Conclusion AHCSafter TACE can reduce tumor load in short term, and it can improve cellular immunity, ameliorate the liver function, increase the quality of life, and make satisfactory effect in the near future. The key point to increase therapeutic efficacy is the embolization of blood vessel and control of heat sink effect by TACE. Interventional therapy is advantageous to widen the indications of AHCS.