中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
31期
2190-2194
,共5页
范文哲%杨建勇%吕明德%谢晓燕%殷晓煜%黄勇慧%匡铭%李鹤平%徐辉雄%李家平
範文哲%楊建勇%呂明德%謝曉燕%慇曉煜%黃勇慧%劻銘%李鶴平%徐輝雄%李傢平
범문철%양건용%려명덕%사효연%은효욱%황용혜%광명%리학평%서휘웅%리가평
癌,肝细胞%放射学,介入性%导管消融术
癌,肝細胞%放射學,介入性%導管消融術
암,간세포%방사학,개입성%도관소융술
Carcinoma,hepatocellular%Radiology,interventional%Catheter ablation
目的 探讨经皮热消融[射频消融(RFA)及微波消融(MWA)]联合经动脉化疗栓塞术(TACE)治疗大肝癌的疗效及预后.方法 2003年5月至2009年5月中山大学附属第一医院TACE联合热消融治疗45例5～10 cm大肝癌患者,肝功能为Child-Pugh A、B级,其中25例行TACE+RFA治疗,20例行TACE+MWA治疗.随访分析疗效、长期生存率及评估影响预后因素.结果 所有患者的联合治疗成功率为100%(86/86),84个肿瘤完全灭活率为94.0%(79/84),并发症发生率为6.7%(3/45).局部及远处复发率分别为66.7%(30/45)和71.1%(32/45),1、2年无瘤生存率为26.7%(12/45)、13.3%(6/45),1、2、3年总生存率分别为80.0%(36/45)、33.3%(15/45)、6.7%(3/45),中位生存期为25.0个月.单因素分析及Cox回归分析结果显示肿瘤＞7.0 cm、肿瘤多发、治疗不完全及术前甲胎蛋白(AFP)≥200μg/L均是导致患者长期生存率差的因素.结论 TACE联合热消融治疗无法手术切除的＞5.0 cm的大肝癌安全有效,＞7.0 cm的病灶建议行以TACE联合热消融为主的综合治疗.肿瘤大小、数目,疗效程度及术前AFP水平是影响患者预后的重要因素.
目的 探討經皮熱消融[射頻消融(RFA)及微波消融(MWA)]聯閤經動脈化療栓塞術(TACE)治療大肝癌的療效及預後.方法 2003年5月至2009年5月中山大學附屬第一醫院TACE聯閤熱消融治療45例5～10 cm大肝癌患者,肝功能為Child-Pugh A、B級,其中25例行TACE+RFA治療,20例行TACE+MWA治療.隨訪分析療效、長期生存率及評估影響預後因素.結果 所有患者的聯閤治療成功率為100%(86/86),84箇腫瘤完全滅活率為94.0%(79/84),併髮癥髮生率為6.7%(3/45).跼部及遠處複髮率分彆為66.7%(30/45)和71.1%(32/45),1、2年無瘤生存率為26.7%(12/45)、13.3%(6/45),1、2、3年總生存率分彆為80.0%(36/45)、33.3%(15/45)、6.7%(3/45),中位生存期為25.0箇月.單因素分析及Cox迴歸分析結果顯示腫瘤＞7.0 cm、腫瘤多髮、治療不完全及術前甲胎蛋白(AFP)≥200μg/L均是導緻患者長期生存率差的因素.結論 TACE聯閤熱消融治療無法手術切除的＞5.0 cm的大肝癌安全有效,＞7.0 cm的病竈建議行以TACE聯閤熱消融為主的綜閤治療.腫瘤大小、數目,療效程度及術前AFP水平是影響患者預後的重要因素.
목적 탐토경피열소융[사빈소융(RFA)급미파소융(MWA)]연합경동맥화료전새술(TACE)치료대간암적료효급예후.방법 2003년5월지2009년5월중산대학부속제일의원TACE연합열소융치료45례5～10 cm대간암환자,간공능위Child-Pugh A、B급,기중25례행TACE+RFA치료,20례행TACE+MWA치료.수방분석료효、장기생존솔급평고영향예후인소.결과 소유환자적연합치료성공솔위100%(86/86),84개종류완전멸활솔위94.0%(79/84),병발증발생솔위6.7%(3/45).국부급원처복발솔분별위66.7%(30/45)화71.1%(32/45),1、2년무류생존솔위26.7%(12/45)、13.3%(6/45),1、2、3년총생존솔분별위80.0%(36/45)、33.3%(15/45)、6.7%(3/45),중위생존기위25.0개월.단인소분석급Cox회귀분석결과현시종류＞7.0 cm、종류다발、치료불완전급술전갑태단백(AFP)≥200μg/L균시도치환자장기생존솔차적인소.결론 TACE연합열소융치료무법수술절제적＞5.0 cm적대간암안전유효,＞7.0 cm적병조건의행이TACE연합열소융위주적종합치료.종류대소、수목,료효정도급술전AFP수평시영향환자예후적중요인소.
Objective To explore the technical success rate, efficacy, overall survival, recurrencefree survival and prognostic factors of transcatheter arterial chemoembolazition (TACE) plus thermal ablations of radiofrequency ablation (RFA) and microwave ablation (MWA) in the patients with large hepatocellular carcinoma (HCC). Methods Forty-five cases with Child-pugh class A, B cirrhosis and large HCC with a maximum tumor between 5.0 cm to 10. 0 cm underwent TACE and thermal ablation. Twenty-five patients received TACE plus RFA while the other 20 patients underwent TACE plus MWA. Their efficacy,long-term survival and prognostic factors were statistically analyzed. Results TACE plus thermal ablation were performed in 84 tumors with a successful rate of 100% (86/86) and a complete ablation rate of 94. 0%(79/84). The major complication rate was 6. 7% (3/45). Local and distant recurrence rates were 66. 7%(30/45) and 71.1% (32/45) respectively. The 1 and 2-year recurrence-free survival rates were 26. 7%( 12/45)and 13. 3% ( 6/45 ). And the 1, 2 and 3-year survival rates were 80. 0% ( 36/45 ), 33. 3%(15/45) and 6.7% (3/45) respectively. Univariate and Cox regression analyses indicated that tumor size ＞7. 0 cm, multi-nodularity, incomplete necrosis and pretherapy α-fetoprotein (AFP) ≥200 μg/L were 4unfavorable prognostic factors for the long-term survival. Conclusion The combined procedures of TACE and percutaneous thermal ablation are both safe and effective for the unresectable large HCC ( ＞ 5.0 cm). It represents an alleviative treatment for those patients with tumor size ＞7. 0 cm. Tumor size, tumor number,completeness of necrosis and AFP level are all significant prognostic factors.
