经动脉化学栓塞和经皮冷冻序贯治疗肝细胞癌/Treatment of hepatocellular carcinoma with transarterial chemoembolization and percutaneous cryourgery
XU Kecheng, NIU Lizhi, ZHOU Qiang et al.
【摘要】
目的: 评价经动脉化学检塞(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一冷冻序贯治疗组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士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1l％和24％(P一0．001)。1、2、3、4和5年平均存活率分别为72％、57％、47％、39％和3l％。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。
【关键词】肝细胞癌；冷冻治疗；经动脉化学栓塞；冷消融；治疗
[Abstraa]
0bjective 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 perfcIrmed with the routine operation；the percutaneous cryosurgery was conducted 2 to 4 weeks after TACE．Thepatients 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士1 7)months(range from 24 to 70 months)，the local recurrence rate of ablated lesion was 1 7％for all the patients，11％and 24％for patients in sequential group and cryoalone groups respectively(P=O．00 1)．The overall 1-。2-，3-，4- and 5-year survival rate was 72％，57％，47％，39％and 31％，respectively．The l-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 z3％)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．
[Key words] Carcinoma，hepatocellular；Cryosurgery；Transarterial chemoembolization; Cryoablation；Treatment
