【作者】 王智；

【导师】 李生伟；

【作者基本信息】 重庆医科大学 ， 普外科， 2012， 硕士

【摘要】 目的研究肝动脉化疗栓塞（TACE）术后联合高能聚焦超声（HIFU）治疗对晚期原发性肝癌病人的临床疗效及评价。方法筛选2007年1月至2011年8月期间的80例晚期原发性肝癌病人，其中单一行TACE治疗的分为A组，TACE术后联合HIFU治疗的分为B组。A组中使用Seldinger法：从股动脉插入血管导管，利用肝血管造影技术显示肿瘤血供，将栓塞剂超选择性注入供应肿瘤的动脉中，造成肿瘤局部血供中断或明显减少，使肿瘤局部一定程度上出现缺血、坏死，并超选择插管至载瘤肝段进行节段性栓塞，使化疗药物沉积在肿瘤组织，达到杀死肿瘤细胞的目的；B组中在TACE治疗1-2周后行HIFU治疗，使用JC型聚焦超声肿瘤治疗系统（中国重庆海扶（HIFU）技术有限公司），在超声实时监控系统的介导下利用HIFU三维扫描治疗系统将超声波聚焦于靶区组织，利用超声波具有的组织穿透性和能量沉积性，将体外发生的超声波聚焦到肿瘤组织（靶区组织），通过高能聚焦超声的热效应，空化效应和机械效应杀死肿瘤细胞。评估和比较两组病人术后临床疗效、肝功、AFP（甲胎蛋白）、MRI和CT的效果。结果在A组中无严重的并发症。在B组中有1例中度发热，1例皮肤灼伤。TACE治疗术前和术后ALT（谷丙转氨酶）、AST（谷草转氨酶）在A组中分别是ALT(59.8±45.9)U/L，AST (76.9±55.5) U/L和ALT (86.7±59.2)U/L，AST(73.7±49.8)U/L；在B组中分别是ALT(63.4±56.8)U/L, AST (72.5±46.6)U/L和ALT (54.3±30.8)U/L, AST(58.3±27.6) U/L, P<0.05.在A组中，术前AFP是(943.1±411ng/ml)，只有6名患者复查AFP(942.8±468.5ng/ml)，P>0.05。在B组中，术前和术后AFP的中位数分别是621.8ng/ml和16.2ng/ml, P<0.05。术后MRI和CT结果显示肿瘤靶区出现凝固性坏死、血供的减少和中断。术后两组临床疗效显效率、有效率、无效率分别是11.4%,65.7%,22.9%和28.9%,62.2%,8.9%,差异有统计学意义，P<0.05。结论对于晚期肝癌患者行TACE术后联合HIFU治疗的临床疗效较单一的TACE治疗更为显著。经治疗后患者肝功能、AFP在一定程度上得到改善，MRI和（或）CT结果显示经治疗后肿瘤大小在一定程度上有缩小，肿瘤血供减少或者消失，肿瘤区域在不同程度上出现凝固性坏死。更多还原

【Abstract】 Aim: to evaluate the efficacy of transcatheter arterialchemoembolization (TACE) plus High-intensity focused ultrasound(HIFU) in the treatment of advanced hepatocellular carcinoma (HCC).Method: Between January2007and August2011,80patients withadvanced hepatocellular carcinoma were selected and divided in twogroups: group A (n=35), in which patients received TACE only; and groupB (n=45), in which HIFU was performed followed by TACE. In group A,with Seldinger method, a vascular catheter was inserted through thefemoral artery, and hepatic angiography was performed. After assessingthe hepatic vascular anatomy, TACE was performed through lobar orsegmental hepatic arteries. In group B, JC type focused ultrasound tumortherapeutic system was used, designed by Chongqing HIFU TechnologyCo, Ltd. Chongqing China. With ultrasound real-time orientation monitordevice, HIFU three-dimensional combination scanning therapeutic deviceprovided a transcutaneous ablation effect results in necrosis of tumor in the target region. Immediate therapeutic effects were assessed at the basisof clinical efficacy, liver enzymes test, AFP, MRI or CT before and afterthe treatments.Results: No severe complications were observed in group A; and ingroup B, one patient got fever and one got skin hurt. In group A, ALT(59.8±45.9) U/L, and AST (76.9±55.5)U/L before TACE treatmentcompared to ALT (86.7±59.2)U/L and AST (73.7±49.8)U/L one-twoweeks after the treatment; In group B, ALT (63.4±56.8)U/L, AST(72.5±46.6)U/L before the TACE-HIFU treatment compare to ALT(54.3±30.8)U/L, AST (58.3±27.6) U/L, P<0.05. In group A, before thetreatment the AFP was (943.1±411ng/ml), only6patients had AFPreviewed (942.8±468.5ng/ml); in group B, the median of AFP before andafter the treatment were621.8ng/ml and16.2ng/ml, respectively, P<0.05.After treatment, MRI or CT findings demonstrated coagulation necrosisand blood supply reduction or disappearance of tumor in the target region.The CR-, PR-, NC-, rate of efficacy differ significantly between group Aand group B (11.4%,65.7%,22.9%, respectively, vs28.9%,62.2%,8.9%,respectively, P<0.05).Conclusion: The patients received TACE prior to HIFU would havebetter efficacy than those who underwent TACE alone. The clinicalefficacy, liver enzymes, AFP got improved to some extent, MRI or CTfindings showed coagulation necrosis and blood supply reduction or disappearance of the tumor in the target region.更多还原