CAJ | 학술논문

目的评价经动脉化学栓塞(TACE)和经皮冷冻序贯治疗无法切除的肝细胞肝癌(HCC)的疗效.方法将420例无法手术切除的HCC患者分为TACE-冷冻序贯治疗组290例(序贯组)和单纯冷冻组130例(冷冻组).TACE按常规操作,术后2～4周行经皮冷冻治疗.1个月及以后每2～3个月随访1次,包括肝脏超声和(或)腹部CT,并检测血清甲胎蛋白(AFP).结果平均随访(42±17)个月(范围24～70个月),所有患者消融灶局部复发率为17%,序贯组和冷冻组分别为11%和24%(P=0.001).1、2、3、4和5年平均存活率分别为72%、57%、47%、39%和31%.序贯组1年和2年存活率(71%和61%)与冷冻组(73%和54%)相似(P值分别=0.69和0.147);而4年和5年存活率,序贯组(49%和39%)高于冷冻组(21%和23%,P=0.001).序贯组有18例肿瘤直径＞5cm的患者存活逾5年,而冷冻组无一例.全组并发症发生率为24%,序贯组和冷冻组分别为21%和26%(P=0.06).冷冻组肝出血的发生率显著高于序贯组(P=0.02),且有2例发生肝破裂.结论冷冻治疗前先行TACE能提高冷冻消融的疗效,减少其并发症,特别是肝出血.TACE和冷冻序贯疗法可能是治疗不能切除性HCC,特别是大肝癌的较好方法 .
목적 평개경동맥화학전새(TACE)화경피냉동서관치료무법절제적간세포간암(HCC)적료효.방법 장420례무법수술절제적HCC환자분위TACE-냉동서관치료조290례(서관조)화단순냉동조130례(냉동조).TACE안상규조작,술후2～4주행경피냉동치료.1개월급이후매2～3개월수방1차,포괄간장초성화(혹)복부CT,병검측혈청갑태단백(AFP).결과 평균수방(42±17)개월(범위24～70개월),소유환자소융조국부복발솔위17%,서관조화냉동조분별위11%화24%(P=0.001).1、2、3、4화5년평균존활솔분별위72%、57%、47%、39%화31%.서관조1년화2년존활솔(71%화61%)여냉동조(73%화54%)상사(P치분별=0.69화0.147);이4년화5년존활솔,서관조(49%화39%)고우냉동조(21%화23%,P=0.001).서관조유18례종류직경＞5cm적환자존활유5년,이냉동조무일례.전조병발증발생솔위24%,서관조화냉동조분별위21%화26%(P=0.06).냉동조간출혈적발생솔현저고우서관조(P=0.02),차유2례발생간파렬.결론 냉동치료전선행TACE능제고냉동소융적료효,감소기병발증,특별시간출혈.TACE화냉동서관요법가능시치료불능절제성HCC,특별시대간암적교호방법 .
Objective To evaluate the efficacy of transarterial chemoembolization (TACE) and percutaneous cryosurgery sequential therapy for unresectable hepatocellular carcinoma (HCC).Methods Four hundred and twenty patients with unresectable HCC were divided into sequential TACE-cryosurgery sequential (sequential) group (n=290) and cryosurgery alone (cryoalone) group (n = 130). TACE was performed with the routine operation; the percutaneous cryosurgery was conducted 2 to 4 weeks after TACE. The patients were followed up at the first month and once every 2 to 3 month later. Liver ultrasound or both computer tomography and alpha fetal protein were examined during follow-up. Results During a mean follow-up of (42±17) months (range from 24 to 70 months), the local recurrence rate of ablated lesion was 17% for all the patients, 11% and 24% for patients in sequential group and cryoalone groups respectively (P=0. 001). The overall 1-, 2-, 3-, 4-and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1- and 2-year survival rates (71% and 61 % ) in sequential group were similar to those (73 % and 54 % ) in cryo-alone group (P=0.69 and 0. 147), while the 4- and 5-year survival rates were higher in sequential group (49 % and 39 % ) than those (29 % and 23 % ) in cryo-alone group (P= 0.001). Eighteen patients with large HCC (＞5 cm in diameter) in sequential group survived for more than 5 years while no one in cryo-alone group. Complication rate was 24% in all patients, 21% and 26% for the sequential and cryo-alone groups respectively (P=0. 06). The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group (P=0. 02). Liver crack occurred in two patients of the cryoalone group. Conclusions Pre-cryosurgical TACE increased the cryoablation efficacy and decrease its complications, especially hepatic bleeding. TACE and cryosurgery sequential therapy may be a better treatment for unresectable HCC, especially for large HCC.