【作者】 李传行； 张福君； 范卫君； 吴沛宏； 黄金华； 张亮； 顾仰葵； 赵明； 黄子林； 高飞；

【Author】 LI Chuan-xing,ZHANG Fu-jun,FAN Wei-jun,WU Pei-hong,HUANG Jin-hua,ZHANG Liang,GU Yang-kui,ZHAO Ming, GAO Fei; JIAO De-chao.State Key Laboratory of Oncology in South China,Department of Imaging and Interventional Center,Cancer Center,Sun Yat-sen University,Guangzhou,Guangdong,510060,P.R.China

【机构】 中山大学附属肿瘤医院医学影像与介入中心；

【摘要】 目的探讨动脉栓塞化疗(TACE)与高强度聚焦超声(HIFU)联合治疗大肝癌的临床应用疗效。方法 68例原发性大肝癌患者分为两组:(1)TACE与HIFU联合组38例,在TACE治疗后2～3周,接受HIFU治疗;(2)单纯TACE组30例。肿瘤最大径5.0～14.5cm,平均(9.3±3.2)cm,计88个瘤块,多发病灶者选其中最大径肿瘤为观察目标。两组病例的平均年龄、病灶大小、肿瘤TNM分期以及肝功能分级差异无显著性意义。全部患者随访3～24个月,平均(13.1±6.8)个月。观察治疗前后病人临床症状、肿瘤标志物(AFP)、肿瘤影像学(CT或MRI或PET)等变化,对患者进行随访以评估治疗后肿瘤凝固性坏死、肿瘤大小、局部复发率和生存预后。结果 TACE与HIFU联合治疗后病人的临床症状缓解率为90.6%(29/32)。TACE与HIFU联合组的肿瘤坏死率为73.7%,肿瘤缩小率为68.4%,单纯TACE组分别为26.7%、33.3%,两组比较,差异有显著性(P<0.01)。两组局部复发率分别为21.1%、33.3%,二者差异无显著性意义(P>0.05)。联合组中位生存期为18月,明显高于TACE组(10月),二者差异有显著性意义(P<0.05)。结论 TACE与HIFU联合治疗大肝癌的疗效明显优于单纯TACE,可提高肿瘤坏死率并延长患者生存期。更多还原

【Abstract】 Objective To investigate the clinical role of a combination therapy of transcatheter arterial chemoembolization(TACE) and high intensity focused ultrasound ablation(HIFU) in larger hepatocellular carcinoma (HCC).Method sixty-eight patients with unresectable HCC were randomized into a TACE group and a TACE plus HIFU group,thirty patients underwent TACE alone,and 38 HIFU ablation 2-3 weeks after TACE.A total of 88 tumors with a mean diameter of(9.3±3.2) cm(ranged from 5.0 to 14.5cm) were detected,and the largest tumor was selected for observation in a patient with multiple lesions.There was no significant difference in mean age,tumor size,TNM stages and liver function grade among the four groups.The mean follow-up time for all patients was 13.1=1=6.8 months (range 3 to 24 months).The patients were followed up and the necrosis of the tumor,size of the tumor,local recurrence and survival of patients were observed.Results After the combined treatment,Clinical symptom remission rate was observed in 90.6%(29/32).Tumor necrosis and minification accounted for 73.7%and 68.4%in combination group, which were significantly higher than that of TACE group(26.7%and 33.3%,P<0.01).Tumor local recurrence was 21.1%,33.3%,respectively in the combination group,TACE group and there was no significant difference among the two groups(P>0.05).Median survival duration of combination group was 18 months,significantly higher than that of TACE group(10 months) with significant differences(P<0.05).Conclusions Compared with TACE therapy alone,the combination therapy improves tumor necrosis rate and prolongs the patients’ survival duration.更多还原