【摘要】 目的探讨经皮射频消融(RFA)联合肝动脉栓塞化疗术(TACE)对无手术切除机会原发性肝癌的治疗价值。方法 74例原发性肝癌患者,41例行单纯TACE治疗,33例行RFA联合TACE治疗,治疗后定期复查B超、CT或MRI,确定肿瘤坏死范围,应用流式细胞术检测治疗前和治疗后4周两组外周血CD4+、CD8+、CD4+/CD8+的变化,采用酶联免疫吸附分析法(ELISA)检测治疗后12周患者血清甲胎蛋白(AFP)的情况,Kaplan-Meier法计算预期生存率并预测平均生存期。结果 TACE组治疗前CD4+为27.23%±6.63%,治疗后为29.15%±6.15%,二者之间差异无显著性意义(P>0.05)。TACE组CD8+、CD4+/CD8+治疗前后均无显著性差异(P>0.05)。联合组治疗后CD4+、CD4+/CD8+明显高于治疗前(P<0.05)。联合组治疗后CD8+显著低于治疗前(P<0.05)。TACE组和联合组术后肿瘤坏死范围分别为(0.27±0.06)cm和(2.06±0.24)cm,二者之间差异有显著性(P<0.01)。联合组术后血清AFP含量为(53.24±7.92)μg·L-1,与TACE组术后血清AFP含量(374.72±23.11)μg·L-1相比差异有显著意义(P<0.01)。联合组术后平均生存时间明显长于TACE组(P<0.01)。结论对无手术切除机会原发性肝癌,经皮射频消融联合肝动脉栓塞化疗可明显改善患者免疫功能以及提高临床疗效。更多还原

【Abstract】 Objective: To investigate the clinical value of percutaneous radio frequency ablation combined with transcathter hepatic arterial chimoembolization( TACE) for treating unresectable primary hepatocellular carcinoma. Methods:Seventy-four patients with primary hepatocellular carcinoma were involved in the study. Forty-one patients were treated with TACE only,and the other 33 patients were performed with the combination of radiofrequency ablation and TACE. After the treatments,untrasonography,CT and MRI were introduced to observe the range of tumor necrosis. Flow cytometry was used to measure the changes of CD4+,CD8+and CD4+/ CD8+in peripheral blood before and after the operation. AFP levels were also detected by enzyme-linked immunosorbent assay and were compared before and after the treatment. Kaplan-Meier survival analysis was used to calculate the survival rate and forecast the mean survival time. Results: The values of CD4+were 27. 23% ± 6. 63% before operation,and 29. 15% ± 6. 15% after operation in TACE group without significant difference( P > 0. 05). And there were no significant differences before and after operation in CD8+and CD4+/ CD8+( P >0. 05). However,in the combination group,the values of CD4+and CD4+/ CD8+after operation were significantly higher than those before the operation( P < 0. 05),and the value of CD8+after operation was significantly lower than that before the peration( P < 0. 05). In addition,the range of tumor necrisis in the cobination group was obviously bigger than that in the TACE group( P < 0. 01),and the content of AFP in combination group was significantly lower than that in the TACE group( P < 0. 01). The mean survival time in the combination group was remarkably longer than that in the TACE group( P < 0. 01). Conclusion: For unresectable primary hepatocellular carcinoma,the combination of percutaneous radiofrequency ablation and transcatheter hepatic arterial chemoembolization can strikingly improve immune function of patients and increase clincal effects of therapy.更多还原