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序贯经动脉化学栓塞联合微波消融治疗原发性肝癌患者的安全性
Safety of sequential transcatheter arterial chemo-embolization combined with microwave ablation for primary liver cancer
【摘要】 目的探讨序贯经动脉化疗栓塞(TACE)联合微波消融治疗原发性肝癌(HCC)患者的安全性。方法选取2014年1月至2016年12月间南通市肿瘤医院收治的33例原发性肝癌患者进行回顾性分析,均采用序贯TACE联合微波消融治疗,分析患者术后1年内丙氨酸氨基转移酶(ALT)、白蛋白(ALB)、总胆红素(T-BIL)、Child-paugh肝功能评分及并发症情况。结果随访1年,患者术后复发5例,无复发转移28例。有慢性乙型肝炎病史19例,接受恩替卡韦抗病毒治疗16例。术后1个月,患者血清ALT由术前(45. 57±25. 71) U/L升高至(54. 56±27. 32) U/L,术后3、6、9和12个月时,分别为(47. 19±21. 46) U/L、(44. 59±20. 81) U/L、(43. 37±22. 05) U/L和(42. 93±21. 55) U/L,与术前比较,差异均无统计学意义(P> 0. 05)。患者血清ALB术前为(37. 07±4. 40) g/L,术后1个月为(32. 82±4. 37) g/L,差异有统计学意义(P <0. 05);术后3个月时上升到术前水平,为(36. 57±6. 27) g/L,差异无统计学意义(P> 0. 05)。血清T-BIL水平及凝血酶原时间在术后随访中与术前相似。术后1个月,3例患者Child-paugh分级为B级,3和6个月时B级各1例,9个月时全部恢复到A级,12个月时B级5例,但差异无统计学意义(P> 0. 05)。患者术后出现的主要并发症为术后发热、疼痛、胆汁湖形成及肝脓肿。2例胆汁湖形成治疗后3个月及9个月,采用经皮肝穿刺置管引流及抗生素治疗,均在1个月内恢复,对肝功能无明显影响。所有并发症均未直接导致因肝功能衰竭引起的死亡。结论序贯TACE联合微波消融治疗5cm以下HCC患者安全可靠,疗效有待进一步研究。
【Abstract】 Objective To explore the safety of short-term sequential transcatheter arterial chemoembolization( TACE) combined with microwave ablation in the treatment of primary liver cancer. Methods Retrospective analysis was performed on 33 patients with primary liver cancer receiving sequential TACE combined with microwave ablation admitted to Nantong Tumor Hospital from January 2014 to December 2016.Among the patients,alanine amino-transferase( ALT),albumin( ALB),total bilirubin( T-BIL),Childpaugh score and complications within one year after surgery were analyzed. Results The follow-up period was 1 year. Post-operative recurrence occurred in 5 patients. The rest 28 patients had non-recurrent and nonmetastatic liver cancer. Of the 28 patients,19 had a history of chronic hepatitis B and 16 received antivirus therapy with entecavir. Serum ALT level in all patients was slightly increased to( 54. 56 ± 27. 32) U/L at 1 month after operation from( 45. 57 ± 25. 71) U/L before operation. At 3,6 and 9 months postoperatively,it gradually decreased to( 47. 19 ± 21. 46) U/L,( 44. 59 ± 20. 81) U/L,( 43. 37 ± 22. 05) U/L,and( 42. 93 ± 21. 55) U/L,respectively,showing no statistical significance compared with before the operation( P > 0. 05). Serum ALB was( 37. 07 ± 4. 40) g/L before surgery,and( 32. 82 ± 4. 37) g/L after the surgery( P < 0. 05),and increased to( 36. 57 ± 6. 27) g/L at 3 months after surgery( P > 0. 05). The serum T-Bil level and prothrombin time were similar to those before operation in postoperative follow-up. At the follow-up of 1 month after surgery,child-paugh was graded as grade B in 3 patients,and 1 was graded as grade B at 3 months and 6 months,and all returned to grade A at 9 months,and 5 were graded as grade B at 12 months. Despite changes in Child classification,there was no significant difference( P > 0. 05). The primay complications included postoperative fever,pain,bile lake formation and liver abscess. Two cases of biliary lake formation occurred at 3 and 9 months after the treatment. Percutaneous transhepatic drainage and antibiotic treatment were applied,and all recovered within 1 month,with no significant effect on liver function. Conclusion Sequential TACE combined with microwave ablation for HCC under 5 cm is safe and reliable,and the efficacy remains to be further studied.
【Key words】 Primary liver neoplasms; Transcatheter arterial chemoembolization; Microwave ablation; Hepatitis B;
- 【文献出处】 中国肿瘤临床与康复 ,Chinese Journal of Clinical Oncology and Rehabilitation , 编辑部邮箱 ,2019年04期
- 【分类号】R735.7
- 【被引频次】7
- 【下载频次】69