摘要
目的 探讨经皮射频消融联合肝动脉、门静脉栓塞化疗在不能手术切除的肝癌治疗中的价值。方法 从 2 0 0 0年 9月至 2 0 0 3年 3月 ,佛山市第一人民医院对符合条件的 2 0例原发性和转移性肝癌病人先行肝动脉栓塞化疗 (TACE)和门静脉栓塞化疗 (PVCE) ,再在B超引导下经皮射频消融 (PRFA)治疗 ;另 2 0例肝癌病人直接给予PRFA治疗。治疗后定期复查B超、CT或MRI。确定肿瘤是否坏死或缩小 ,有无复发转移灶 ,肿瘤特异指标的变化。Kaplan Meier法计算无瘤生存率和累积生存率。结果 对于转移性肝癌 ,联合治疗组CEA阳性者治疗转阴率 5 0 % (2 / 4 ) ,单纯治疗组CEA阳性者治疗后转阴率 2 5 % (1/ 4 ) ,差异有显著意义。对于原发性肝癌或复发肝癌 ,联合治疗组AFP阳性者治疗后转阴率 6 2 5 % (5 / 8) ,单纯治疗组AFP阳性者治疗后转阴率30 % (3/ 10 ) ,差异有显著意义。肿瘤完全凝固坏死率 :单纯治疗组对于 <3cm瘤灶为 10 0 % (17/ 17) ,3～ 5cm为5 5 % (5 / 9) ,>5cm为 2 0 % (1/ 5 ) ;而联合治疗组 <3cm瘤灶为 10 0 % (19/ 19) ,3～ 5cm为 75 % (3/ 4 ) ,>5cm为4 0 % (2 / 5 )。肿瘤缩小率为 70 % (14 / 2 0 ) ,门静脉癌栓消失率为 2 5 % (1/ 4 ) ,缩小率为 5 0 % (2 / 4 )。肝内复发转移时间明显延长。
Objective To explore the clinical value of percutaneous radiofrequency ablation (PRFA) combining with transcatheter hepatic artery chemoembolization (TACE) and portal vein chemoembolization (PVCE) in treatment of unresectable hepatocarcinoma. Methods From Sep 2000 to Mar 2003,in First People's Hospital of Foshan 20 patients with primary or metastatic hepatocarcinoma were treated with TACE and PVCE,and then were performed PRFA under the guidance of ultrasonography. Another 20 patients with primary or metastatic hepatocarcinoma were given PRFA treatment only. After the treatments,ultrasonography,CT and MRI were introduced to examine tumor necrosis,size reduction,recurrence,and metastasis. The changes of the specific tumor biological index were also tested. Kaplan-Meier method was deployed to calculate tumor-free survival rate and cumulative survival rate. Results For metastatic hepatocarcinoma,CEA negative conversion rate of combined treatment group was 50% (2/4),whereas that of single treatment group was 25% (1/4). The difference was significant.For primary and recurrent hepatocarcinoma,the two groups also showed significant difference in AFP negative conversion rate (combined treatment group 62.5% vs single treatment group 30%). The complete tumor necrosis rate differed according to the size of the tumor. In both group,they were 100% (combined treatment group 19/19,single treatment group 17/17)when the tumor size was smaller than 3 cm. When the size was between 3 and 5 cm,it was 75%(3/4) in the combined treatment group,while that was 55%(5/9) in the group of single treatment. When the size was larger than 5 cm,they were 40% and 20% in the two groups respectively (combined treatment group 2/5,single treatment group 1/5). In combined treatment group,tumor reduction rate was 70% (14/20).Cancer embolus disappearance rate was 25% (1/4) and reduction rate was 50% (2/4) in portal vein. Besides,in combined treatment group the period of intrahepatic recurrence and metastasis also prolonged significantly. The
出处
《中国实用外科杂志》
CSCD
北大核心
2004年第8期480-482,共3页
Chinese Journal of Practical Surgery
基金
广东省医学科研基金 (A2 0 0 2 696)
