肝动脉化疗栓塞术联合超声引导下微波消融术治疗特殊部位原发性肝癌患者疗效及安全性分析 *

目的 分析经肝动脉化疗栓塞术（TACE）联合超声引导下微波消融术治疗特殊部位肝细胞癌（HCC）患者的临床疗效及安全性。方法 2012年1月~2015年1月我院收治的特殊部位HCC患者（观察组）36例和同期收治的普通部位HCC患者36例（对照组）,采用TACE联合超声引导下微波消融术治疗,并在治疗完成后对两组患者进行为期2年的随访,比较临床治疗效果和不良反应发生情况,应用Kaplan-Meier法分析患者生存情况。结果 近期考核,观察组完全缓解、部分缓解、疾病稳定和疾病进展发生率分别为44.4%、25.0%、19.5%和11.1%,与对照组的47.2%、27.8%、16.7%和8.3%比,差异无统计学意义（P>0.05）;观察组血清AFP阴转率为84.4%,与对照组的83.9%比,差异无统计学意义（P>0.05）;观察组6 m、1 a、18 m和2 a生存率分别为94.4%、88.9%、69.4%和44.4%,与对照组的100.0%、91.7%、75.0%和47.2%比,差异无统计学意义（P>0.05）;两组患者在术后肝区疼痛、发热、食欲减退和肝功能轻度异常等不良反应发生率比较,差异无统计学意义（P>0.05）。结论 采用TACE联合超声引导下微波消融术治疗特殊部位的肝癌患者,其疗效和安全性均较好,但在操作过程中,需做好各种应激准备,精心处理,防止并发症的发生。

Efficacy of transcatheter arterial chemoembolization and ultrasound-guided microwave ablation in the treatment of patients with hepatocellular carcinoma at special sites

Objective To investigate the efficacy of transcatheter arterial chemoembolization （TACE） and ultrasound-guided microwave ablation in the treatment of patients with hepatocellular carcinoma（HCC） at special sites. Methods Seventy-two patients with HCC,out of them,thirty-six with HCC at special sites （observation group）,were enrolled in our hospital between January 2012 and January 2015,and all of them received TACE and ultrasound-guided microwave ablation seven days after. The patients with HCC in the two groups were followed- up for two years after the treatment was completed. The survival was analyzed by Kaplan-Meier methods. Results The rates of complete response,partial response,disease stable and disease progress in the observation group were 44.4%,25.0%,19.5% and 11.1%,not significantly different as compared to 47.2%,27.8%,16.7% and 8.3% in the control（P>0.05）;serum AFP negativity rate in the observation group was 84.4%,not significantly different as compared to 83.9% in the control（P>0.05）;the survival rates at 6 m,1 a,18 m and 2 a were 94.4%,88.9%,69.4% and 44.4%,not significantly different as compared to 100.0%,91.7%,75.0% and 47.2%,respectively（P>0.05）;the incidences of right hypochondriac region pain,fever,anorexia and abnormal liver function tests after operations in the two groups were not significantly different（P>0.05）. Conclusion The application of hepatic artery chemoembolization combined with ultrasound-guided microwave ablation in the treatment of patients with HCC at special sites might have the same clinical efficacy as usual,but we still remind clinicians taking much more attention to those patients during the process.