经导管肝动脉化疗栓塞联合微波消融治疗大肝癌的临床研究

发布时间：2018-05-27 11:41

本文选题：经导管肝动脉化疗栓塞 + 微波消融　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:通过对比观察经导管肝动脉化疗栓塞(TACE)联合微波消融(MWA)与单纯经导管肝动脉化疗栓塞治疗大肝癌的近期疗效和不良反应,评价经导管肝动脉化疗栓塞联合微波消融在大肝癌治疗中的近期临床疗效与安全性。方法:收集青岛大学附属医院2013年1月1日至2014年11月30日就诊的大肝癌患者68例,其中男61例,女7例,年龄38?74岁。根据治疗方式不同,分为联合组(36例)和对照组(32例),联合组经1?2次TACE治疗后2?4周内联合MWA治疗,对照组行2次以上TACE治疗,两组中AFP阳性患者分别为31例(86.1%)和26例(81.3%)。术后1月、3月、6月复查,而后每3?6个月复查,包括CE-CT、CE-MRI、肝功、甲胎蛋白(AFP),观察肿瘤大小、坏死情况及有无复发、转移等情况。接受治疗1个月后根据影像检查评价两组患者的近期疗效。记录不良反应和并发症发生情况、治疗次数以及患者生存时间,通过统计学软件进行对比分析。结果:两组患者在年龄、性别、Child-Pugh分级、病灶数目、最大长径、AFP阳性率方面无明显差异(P0.05)。联合组及对照组分别平均治疗3.6±1.2次、4.9±1.8次,两组差异具有统计学意义(P0.05)。联合组CR 20例(55.6%)、PR 10例(27.8%)、SD 2例(5.6%)、PD 4例(11.1%)、RR 30例(83.3%),对照组CR 8例(25%)、PR 8例(25%)、SD 4例(12.5%)、PD 12例(37.5%)、RR 16例(50%),联合组完全缓解率(CR)、疾病控制率(RR)及术后AFP转阴率均明显优于对照组(P0.05)。联合组与对照组的生存期分别为17.5±6.32个月和13.25±6.73个月,差异具有统计学意义(P0.05)。联合组与对照组中位生存期分别为19个月和12个月,差异具有统计学意义(P0.05)。联合组在12、18、24月的患者生存率优于对照组(P0.05)。联合组肩胛部酸痛、肝区疼痛的发生率明显高于对照组(P0.05),两组患者低热等不良反应和严重并发症的发生率无明显差异(P0.05)。两组均未出现术中死亡病例。结论:TACE联合MWA治疗大肝癌较单纯TACE治疗手术次数减少,创伤小,近期疗效确切,安全性高,是大肝癌的有效治疗模式,具有临床推广价值。
[Abstract]:Objective: to observe the short-term efficacy and adverse reactions of transcatheter hepatic arterial chemoembolization (TACEE) combined with microwave ablation (MWA) and transcatheter arterial chemoembolization (TACE) in the treatment of large hepatocellular carcinoma (HCC). To evaluate the efficacy and safety of transcatheter hepatic arterial chemoembolization (TACE) combined with microwave ablation in the treatment of large liver cancer. Methods: a total of 68 patients with large liver cancer from January 1, 2013 to November 30, 2014, including 61 males and 7 females, aged 38 to 74 years, were collected from affiliated Hospital of Qingdao University. According to the different ways of treatment, they were divided into two groups: the combined group (36 cases) and the control group (32 cases). The combined group was treated with MWA within 2 weeks after two TACE treatments. The control group received more than 2 times of TACE treatment. 31 cases of AFP positive patients in the two groups were treated with TACE. 1 month, 3 months, 6 months after operation, then every 36 months, including CE-CTT CE-MRI, liver function, AFP, tumor size, necrosis, recurrence, metastasis and so on. One month after treatment, the short-term efficacy of the two groups was evaluated according to imaging examination. Adverse reactions and complications, times of treatment and survival time of patients were recorded and analyzed by statistical software. Results: there was no significant difference in age, sex, Child-Pugh grade, number of lesions and AFP positive rate of the maximum length of diameter between the two groups (P 0.05). The combined group and the control group were treated with an average of 3.6 卤1.2 times and 4.9 卤1.8 times, respectively. The difference between the two groups was statistically significant (P 0.05). In the combined group, there were 20 cases of PR with 55.6% PR and 2 cases of SD with SD of 5.66%. In the combined group, the complete remission rate, the disease control rate and the AFP negative conversion rate in the combined group were significantly higher than those in the control group (P 0.05) and the control group (n = 8). The total remission rate, the disease control rate and the AFP negative conversion rate in the combined group were significantly higher than those in the control group (P 0.05). The survival time of the combined group and the control group was 17.5 卤6.32 months and 13.25 卤6.73 months, respectively. The difference was statistically significant (P 0.05). The median survival time of the combined group and the control group was 19 months and 12 months, respectively. The difference was statistically significant (P 0.05). The survival rate of the combined group was better than that of the control group at 12 and 24 months (P 0.05). The incidence of scapular pain and liver pain in the combined group was significantly higher than that in the control group (P 0.05). There was no significant difference in the incidence of adverse reactions such as low fever and serious complications between the two groups. There were no cases of intraoperative death in both groups. Conclusion compared with TACE alone, the treatment of large liver cancer with MWA combined with 10% TACE has fewer surgical procedures, less trauma, better short-term curative effect and higher safety. It is an effective treatment mode for large liver cancer and has the value of clinical popularization.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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