TAE联合HIFU治疗早期肝癌的近期疗效及复发的危险因素

发布时间：2018-12-18 18:52

【摘要】：目的:探讨肝动脉栓塞术后联合高强度聚焦超声治疗早期肝癌的近期疗效,并明确哪些因素是其治疗后复发的危险因素。方法:选取2013年1月至2015年3月间重庆医科大学附属第二医院HIFU中心收治的早期肝癌患者,共39例,TNM分期T1~2N0M0,所有患者均行1次TAE术,术后间隔1-2周行1次HIFU治疗。其中TAE采用重庆医科大学附属第二医院蓝盾介入中心常规方法,即从股动脉插入导管,注入造影剂使血管显影后,选择性地将碘油栓塞剂注入肿瘤供血动脉中,使其血供中断或减少以造成肿瘤组织缺血坏死。HIFU治疗采用JC型聚焦超声肿瘤治疗系统(中国重庆海扶技术有限公司),在全麻下利用超声实时监控系统精确定位于肝癌病灶,通过聚焦超声的热效应、空化效应以及机械效应杀灭肿瘤细胞。通过分析其临床资料,包括年龄、肿瘤大小、肿瘤位置(是否邻近大血管、胆囊窝及膈肌)、治疗前白蛋白、HBV-DNA定量及治疗前后血清甲胎蛋白(AFP)、治疗后并发症等,并通过治疗前后及3月后复查的MRI显示的肿瘤大小计算HIFU消融率及治疗后3月肿瘤的缩小率,通过比较治疗前后AFP变化、HIFU消融率、治疗后并发症、3月后肿瘤缩小率及复发时间,分析其疗效及复发的危险因素。其中治疗前后资料的对比使用t检验,分类资料的比较采用Fisher确切概率法,多因素分析则构建多因素logistic回归模型。P0.05被认为差异有统计学意义。所有统计学分析懫用SPSS19.0软件进行。结果:(1)39例患者中,治疗前血清AFP升高者于治疗后有不同程度下降,治疗后复查MRI可见原病灶内明显凝固性坏死区,肿瘤消融率绝大部分可达90%以上,治疗后3月复查MRI见绝大部分肿瘤有不同程度缩小。所有患者术后均未出现严重并发症。(2)单因素分析发现,肿瘤邻近大血管或胆囊、膈肌及HBV-DNA定量1×103IU/ml的患者,1年内复发几率较高(p0.05),而不同年龄、肿瘤直径、白蛋白、AFP水平与是否复发之间无统计学意义(p0.05)。多因素分析结果显示,血清AFP水平及HBV-DNA定量与治疗后复发相关,p0.05,有统计学意义,其他因素与治疗后是否复发无相关性(p0.05)。结论:TAE联合HIFU治疗早期肝癌是有效而可行的,且肿瘤位置(是否邻近大血管、胆囊窝及膈肌)及HBV-DNA复制数是治疗后复发的独立危险因素,而治疗前血清AFP水平是复发的非独立危险因素。
[Abstract]:Objective: to investigate the short-term efficacy of hepatic artery embolization combined with high intensity focused ultrasound (HIFU) in the treatment of early hepatocellular carcinoma (HCC) and to identify the risk factors for recurrence. Methods: from January 2013 to March 2015, 39 patients with early liver cancer were treated in HIFU Center of the second affiliated Hospital of Chongqing Medical University. All patients were treated with TAE once every 1-2 weeks after operation. Among them, TAE used the routine method of blue shield interventional center in the second affiliated Hospital of Chongqing Medical University, that is, inserting catheter from femoral artery, injecting contrast agent to make blood vessel development, then selectively injecting lipiodol embolization into tumor blood supply artery. The HIFU was treated with JC focused ultrasound tumor therapy system (China Chongqing Haifu Technology Co., Ltd.). Under general anesthesia, real-time ultrasound monitoring system was used to accurately locate the focus of liver cancer. The thermal, cavitation and mechanical effects of focused ultrasound were used to kill tumor cells. The clinical data, including age, tumor size, tumor location (adjacent to large blood vessels, gallbladder fossa and diaphragm), prealbumin, HBV-DNA quantification and complications after treatment with alpha-fetoprotein (AFP), were analyzed. The ablation rate of HIFU was calculated by MRI before and after treatment and 3 months after treatment. The changes of AFP, the ablation rate of HIFU, and the complications after treatment were compared before and after treatment. After 3 months, the reduction rate and recurrence time of tumor were analyzed, the curative effect and the risk factors of recurrence were analyzed. Among them, t test was used to compare the data before and after treatment, Fisher exact probability method was used to compare the classified data, and multivariate logistic regression model was constructed by multivariate analysis. P0.05 was considered to have statistical significance. All statistical analysis was performed with SPSS19.0 software. Results: (1) in 39 patients, the patients with elevated serum AFP decreased in varying degrees after treatment. After treatment, MRI showed obvious coagulative necrosis in the lesion, and the tumor ablation rate was more than 90%. 3 months after treatment, MRI showed that most of the tumors were reduced to varying degrees. No serious complications were found in all patients. (2) univariate analysis showed that patients with tumor adjacent to large vessels or gallbladder, diaphragm and HBV-DNA 1 脳 103IU/ml had a higher recurrence rate within one year (p0. 05), but at different ages. There was no significant correlation between tumor diameter, albumin, AFP levels and recurrence (p0. 05). The results of multivariate analysis showed that the level of serum AFP and the quantity of HBV-DNA were correlated with the recurrence after treatment (p0.05), while the other factors had no correlation with the recurrence after treatment (p0.05). Conclusion: TAE combined with HIFU is effective and feasible in the treatment of early hepatocellular carcinoma. The location of tumor (adjacent to large vessels, gallbladder fossa and diaphragm) and the number of HBV-DNA replication are independent risk factors for recurrence after treatment. Serum AFP level was an independent risk factor for recurrence before treatment.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R735.7

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