【摘要】 目的研究射频消融(RFA)联合CT引导下经皮碘海醇混合无水乙醇注射(PIEI)与经皮肝动脉化疗栓塞(TACE)序贯RFA治疗高危部位肝癌的临床价值。方法纳入64例高危部位肝癌患者作为研究对象,采用随机数字表法将患者分为观察组与对照组,每组32例。观察组行RFA+PIEI干预,对照组行TACE序贯RFA治疗,比较2组治疗效果,记录疾病控制率。在治疗前后检测血清γ-谷氨酰转移酶(GGT)与血清血管内皮生长因子受体-2(VEGFR-2)水平,分析血清GGT与VEGFR-2判断高危部位肝癌疗效预后的价值。结果观察组患者总体疗效和疾病控制率均高于对照组,差异有统计学意义(P<0.05);观察组肝功能损伤和胆道出血严重程度较对照组显著减轻,差异均有统计学意义(P<0.05)。2组胃肠道反应和气胸严重程度差异无统计学意义(P>0.05);治疗后观察组血清GGT和VEGFR-2水平较治疗前均显著降低,且低于对照组,差异均有统计学意义(P<0.05)。观察组不良预后患者血清GGT和VEGFR-2显著高于存活者,差异均有统计学意义(P<0.05)。观察组与对照组患者生存率差异无统计学意义(P>0.05)。受试者工作曲线分析结果显示,血清GGT和VEGFR-2对于判断RFA+PIEI患者预后具有一定应用价值(AUC>0.05,P<0.05)。结论 RFA联合PIEI治疗高危部位肝癌近期疗效优于TACE序贯RFA,两种方案中远期疗效相近,监测血清GGT和VEGFR-2有助于判断RFA+PIEI患者的预后。更多还原

【Abstract】 Objective To study the clinical value of radiofrequency ablation(RFA)combined with percutaneousiohexol ethanol injection(PIEI)and transcatheter arterial chemoembolization(TACE) sequential RFA in the treatment of high-risk liver cancer.Methods 64 patients with high-risk liver cancerwere selected as the research objects,64 patients were randomlydivided into theobservation group and thecontrol group,32 cases in each group.The observation group received RFA +PIEI intervention,and the control group received TACE sequential RFA treatment.The therapeutic effects of the two groups were compared and the disease control rate was recorded.The levels of serum γ-glutamyltransferase(GGT)and vascular endothelial growth factor receptor-2(VEGFR-2)were measured before and after treatment,the prognostic value of serum GGT and VEGFR-2 in high-risk liver cancer was analyzed.Results The overall efficacy and disease control rate of the observation group were higher than those of the control group,the difference were statistically significant(P<0.05).Compared with the control group,the severity of liver function injury and biliary tract hemorrhage in the observation group was significantly reduced(P <0.05).There were no significant difference in gastrointestinal reaction and pneumothorax severity between the two groups(P>0.05).After treatment,the serum levelsofGGT and VEGFR-2 in the observation groupwere reduced,which were significantly lower than those in the control group(P<0.05).The serum GGT and VEGFR-2 in the observation group were significantly higher than those in the survivors,the difference were statistically significant(P<0.05).There was no significant difference in survival rate between the observation group and the control group(P >0.05).The receiver operating curveanalysis showed that the serum levels of GGT and VEGFR-2 had certain value in judging the prognosis of patients with RFA +PIEI(AUC >0.05,P <0.05).Conclusion The RFA combined with PIEI is better than TACE sequential RFA in the treatment of high-risk liver cancer in the short term,and the long-term effects of the two schemes are similar.It is helpful to judge the prognosis of patients with RFA+PIEI by monitoring the GGT and VEGFR-2 in serum.更多还原