超声引导下激光与射频消融治疗小肝癌疗效的对比研究

发布时间：2018-05-27 21:13

本文选题：超声 + 激光消融　；参考：《东南大学》2017年硕士论文

【摘要】：小肝癌是指单个肝癌结节直径≤3cm或者相邻两个肝癌结节的直径之和≤3cm,其早期诊治是提高患者生存质量、降低死亡率的关键举措[1]。现在临床上治疗小肝癌的首选治疗手段仍为手术切除,但由于大部分肝癌患者伴有肝炎、肝硬化等基础疾病,不适宜采取手术切除的方式,从而使得非手术手段在小肝癌治疗中的应用越来越广泛。近年来,随着诊疗技术的进步,小肝癌的早期诊断率越来越高,原位消融肝癌治疗技术已逐步成为小肝癌首选的治疗措施[2],其中射频消融术(RFA)具有安全可靠、易耐受、术后并发症少等优势,在造成局部肝细胞死亡同时保留了肝脏组织的正常形态,是继手术切除和肝脏移植之后的首选治疗手段。与此同时,近期新发展起来的激光消融术(LA)也被应用于肝癌的治疗。本研究通过对超声引导下激光消融和射频消融治疗小肝癌病例疗效的对比性分析,探讨超声引导下激光消融和射频消融两种方法在介入治疗小肝癌方面的优缺点,为临床治疗肝癌提供更优化的治疗方案以及数据支持。本研究分为两个部分:第一部分:在超声引导下进行小肝癌的激光消融治疗,对激光消融前后的超声造影结果及治疗指标进行比较,同时记录发生的各种并发症,分析激光治疗小肝癌的效果,为激光消融和射频消融的比较奠定基础。第二部分:在第一部分的基础上,将两组小肝癌患者分别进行激光消融和射频消融治疗,将两种消融方法的超声造影结果及评价指标进行组间比较,同时记录发生的各种并发症,分析激光消融和射频消融治疗小肝癌的优缺点。第一部分超声引导下激光消融小肝癌的治疗效果目的探讨在超声引导下激光消融治疗小肝癌的治疗效果。方法选取2013年10月～2015年3月于江阴市人民医院就诊且血清甲胎蛋白(AFP)升高的原发性小肝癌患者27例共31个病灶,在超声引导下进行激光消融(LA)治疗,将治疗后一个月的超声造影(CEUS)结果和AFP水平与术前进行比较,并统计各种并发症的发生率,分析激光消融治疗小肝癌的效果。结果与治疗前相比,治疗后超声造影显示病灶完全缓解率87.1%(28/31),部分缓解率12.9%(3/31),AFP较术前明显降低且术后并发症轻微,其中腹痛发生率59.2%,发热发生率11.1%,恶心发生率44.4%,呕吐发生率18.5%,腹泻发生率3.7%。结论激光消融对小肝癌患者有着较好的治疗效果,且术后并发症发生率低而轻。第二部分超声引导下激光和射频消融治疗小肝癌的效果比较目的对超声引导下激光和射频消融治疗小肝癌的效果进行比较,分析激光消融和射频消融治疗小肝癌的优缺点。方法选择行消融治疗的原发性小肝癌患者93例,分为激光消融组(LA组)43例52个病灶和射频消融组(RFA组)50例57个病灶,比较两种消融方法的治疗效果和血清甲胎蛋白(AFP)的恢复情况,记录两组治疗的各种并发症的发生率并进行比较。结果超声造影结果显示LA组完全缓解率90.4%(47/52),部分缓解率9.6%(5/52),RFA完全缓解率91.2%(52/57),部分缓解率8.8%(5/57),两组之间差异无统计学意义(p0.05);两组小肝癌患者血清甲胎蛋白(AFP)水平较术前均明显降低且两组间恢复率未见明显统计学差异(p0.05);各种并发症中,两组之间轻微并发症发生率两组之间无明显统计学差异(P0.05),严重并发症的发生率RFA组明显高于LA组(p0.05)。结论超声引导下LA和RFA均是治疗小肝癌的有效方法,相比而言,LA操作简单,严重并发症的发生率较RFA低。
[Abstract]:Small hepatocellular carcinoma (HCC) refers to the diameter of a single hepatoma nodule in diameter less than 3cm or the diameter of two adjacent liver nodules or less than 3cm. Early diagnosis and treatment is the key measure to improve the patient's quality of life and reduce the mortality rate. The first choice of treatment for small hepatocellular carcinoma is still surgical excision, but most of the liver cancer patients are accompanied by hepatitis, cirrhosis and so on. Basic diseases, which are not suitable for surgical resection, make the use of non-surgical methods more and more widely used in the treatment of small liver cancer. In recent years, with the progress of diagnosis and treatment technology, the early diagnosis rate of small liver cancer is becoming higher and higher. In situ ablation of liver cancer treatment technology has gradually become the first choice for small liver cancer treatment [2], of which radiofrequency ablation is used. RFA, which has the advantages of safe and reliable, easy to endure, and less complications after operation, has retained the normal form of liver tissue in the cause of local hepatocyte death and is the first choice after surgical resection and liver transplantation. At the same time, the recent development of LA is also used in the treatment of liver cancer. A comparative analysis of the efficacy of ultrasound-guided laser ablation and radiofrequency ablation in the treatment of small hepatocellular carcinoma (RFCA). The advantages and disadvantages of two methods of interventional therapy for small hepatocellular carcinoma with ultrasound guided laser ablation and radiofrequency ablation are discussed, which provide more optimal treatment and data support for the clinical treatment of liver cancer. This study is divided into two parts: One part: the laser ablation treatment of small liver cancer under the guidance of ultrasound, compare the results of ultrasound contrast and treatment before and after laser ablation, record all kinds of complications, analyze the effect of laser treatment for small liver cancer, and lay the foundation for the ratio of laser ablation and radiofrequency ablation. The second part: the basis of the first part Two groups of small liver cancer patients were treated with laser ablation and radiofrequency ablation respectively. The results and evaluation indexes of the two ablation methods were compared, and the various complications were recorded. The advantages and disadvantages of laser ablation and radiofrequency ablation for the treatment of small liver cancer were analyzed. Objective to investigate the therapeutic effect of laser ablation in the treatment of small liver cancer under ultrasound guidance. Methods 27 patients with primary small hepatocellular carcinoma (HCC) who had been diagnosed with elevated serum alpha fetoprotein (AFP) in Jiangyin from October 2013 to March 2015 were selected and treated with laser ablation (LA) under ultrasound guidance. The results of CEUS and AFP were compared with preoperative, and the incidence of various complications was counted and the effect of laser ablation on small liver cancer was analyzed. Compared with before treatment, the total remission rate of the lesion was 87.1% (28/31), the partial inhibition rate was 12.9% (3/31), AFP was significantly lower and postoperative complications were significantly lower than that before the treatment. The incidence of abdominal pain was 59.2%, the incidence of fever was 11.1%, the incidence of nausea was 44.4%, the incidence of vomiting was 18.5%, and the incidence of diarrhea was 3.7%.. Conclusion laser ablation has a good therapeutic effect on the patients with small liver cancer, and the incidence of postoperative complications is low and light. Second parts of ultrasound guided laser and radiofrequency ablation for small liver cancer are compared. The advantages and disadvantages of laser ablation and radiofrequency ablation in the treatment of small liver cancer were compared, and the advantages and disadvantages of laser ablation and radiofrequency ablation in the treatment of small liver cancer were analyzed. Methods 93 cases of primary small hepatocellular carcinoma treated with ablation treatment were divided into 43 cases of laser ablation group (Group LA), 52 lesions and 50 cases of radiofrequency ablation group (group RFA) with 57 lesions, and two species were compared. The curative effect of the ablation method and the recovery of serum alpha fetoprotein (AFP) were recorded and the incidence of various complications in the two groups was recorded and compared. Results the complete remission rate of LA group was 90.4% (47/52), the partial remission rate was 9.6% (5/52), the rate of complete remission of RFA was 91.2% (52/57), the partial remission rate was 8.8% (5/57), and the difference between the two groups was different. There was no statistical significance (P0.05). The level of serum alpha fetoprotein (AFP) in two groups of small liver cancer patients was significantly lower than that before operation and no significant difference was found between the two groups (P0.05). Among the complications, there was no significant difference between the two groups between the two groups (P0.05), and the incidence of severe complications was significantly higher in the RFA group. In group LA (P0.05). Conclusion ultrasound guided LA and RFA are effective methods for the treatment of small hepatocellular carcinoma. Compared with LA, the operation is simple and the incidence of serious complications is lower than that of RFA.
【学位授予单位】：东南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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