肝动脉栓塞化疗联合CT引导精准微波消融治疗原发性肝癌患者疗效及对外周血T淋巴细胞亚群的影响

doi:10.3969/j.issn.1672-5069.2017.04.022

摘要/Abstract

摘要： 目的探讨肝动脉栓塞化疗（TACE）联合CT引导精准微波消融治疗原发性肝癌患者的疗效及对外周血淋巴细胞亚群的的影响。方法 2010年1月~2014年12月新疆维吾尔自治区阿克苏地区第一人民医院肿瘤内科收治的原发性肝癌患者60例,对30例患者行TACE治疗,另30例在行TACE治疗后7天接受CT引导下精准微波消融术。采用酶联免疫吸附法测定血清α-L-岩藻糖苷酶水平,使用流式细胞仪检测外周血T淋巴细胞亚群水平。结果在治疗3个月后,TACE治疗患者临床有效率为50%（15/30）,显著低于联合治疗组患者的83.3%（25/30,P<0.05）;联合治疗患者2 a生存率为70.0%,显著高于TACE治疗组的43.3% （P<0.05）;联合治疗患者2 a复发率为10%,显著低于TACE的36.7%（P<0.05）;治疗后,联合组外周血CD4⁺、CD8⁺、CD4⁺/CD8⁺比值、血清α-L-岩藻糖苷酶水平分别为（39.05±4.07）%、（21.35±3.24）%、（1.67±0.21）、（17.91±2.98） u/L,较TACE组的（28.63±3.61）%、（35.12±4.62）%、（0.96±0.11）、（26.03±4.75） u/L改善更明显（P<0.05）;治疗期间,两组患者均在TACE术后出现一些轻症反应,如腰酸、腹胀、恶心等,予以对症治疗及护理后均消失。结论 TACE联合CT引导下经皮精准微波消融治疗原发性肝癌患者临床效果确切。与单用TACE治疗比,可提高长期生存率,降低复发率,纠正机体免疫功能紊乱。

关键词: 原发性肝癌, 肝动脉栓塞化疗, CT引导, 微波消融, 临床疗效

Abstract: Objective To investigate the clinical effect of transcatheter hepatic arterial chemoembolization (TACE) combined with CT-guided precision microwave ablation on patients with primary liver cancer and its influence on immune founction. Methods 60 patients with primary liver cancer including 42 men and 18 women admitted to our hospital between January 2010 and December 2014,and they were divided into control and observation group with 30 cases in each group according to the hospitalization order. Patients in control group were treated with TACE,and in observation group received TACE combined with CT-guided precision microwave ablation. The clinical effect,2 annual survival rate,the relapse rates and the subsets of T-lymphocytes and serum alpha-L-fucosidase levels were compared between the two groups. Results At the end of three month therapy,the clinical effect in observation group was 83.3%（25/30）,significantly higher than 50%（15/30） in the control group （P<0.05）;the two annual survival rate in the observation group was 70.0%,much higher than 43.3% in the control group（P<0.05）;the relapse rate in the observation group was 10.0%, significantly lower than 36.7% in the control （P<0.05）;After therapy,the percentage of CD4⁺T-lymphocytes,CD8⁺T-lymphocytes, the ratio of CD4⁺/CD8⁺,serum alpha-L-fucosidase levels in the observation group was（39.05±4.07）%,（21.35±3.24）%,（1.67±0.21）,（17.91±2.98） u/L,markedly improved as compared to those in the control group[（28.63±3.61）%,（35.12±4.62）5,（0.96±0.11）,（26.03±4.75）u/L,respectively,P<0.05];Additionally,all patients appeared some mild reactions after TACE,such as backache,abdominal distension,nausea,etc,and they disappeared after symptomatic treatment and nursing. The adverse reactions between the two groups showed no statistically difference. Conclusion Transcatheter hepatic arterial chemoembolization combined with CT-guided precision microwave ablation have definite curative effect on patients with primary liver cancer,which could improve the survival rate,and decrease relapse rate.

Key words: Primary liver cancer, Transcatheter hepatic arterial chemoembolization, CT-guided precision, Microwave ablation, Survival

曹焱, 姜峰, 张超, 潘慧丽. 肝动脉栓塞化疗联合CT引导精准微波消融治疗原发性肝癌患者疗效及对外周血T淋巴细胞亚群的影响[J]. 实用肝脏病杂志, 2017, 20(4): 468-471.

Cao Yan, Jiang Feng, Zhang Chao, et al.. Clinical effect of transcatheter hepatic arterial chemoembolization combined with CT-guided precision microwave ablation on patients with primary liver cancer[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(4): 468-471.

参考文献

[1] 世界卫生组织,臧恒佳. 全球癌症报告.抗癌,2015,28（2）：43-45.
[2] 黄乾荣,张玲. 原发性肝癌治疗研究新进展.实用医学杂志,2016,32（14）：2275-2278.
[3] 侯帅,樊琳琳. 非手术治疗原发性肝癌研究进展.实用肝脏病杂志,2016,19（2）：249-252.
[4] 杨秉辉,任正刚. 原发性肝癌诊断标准.中华肝脏病杂志,2000,8（3）：135-135.
[5] Edeline J,Boucher E,Rolland Y,et al. Comparison of tumor response by response evaluation criteria in solid tumors （recist） and modified recist in patients treated with sorafenib for hepatocellular carcinoma.Cancer,2012,118（1）:147-156.
[6] Yao X,Yan D,Zeng H,et al. Concurrent sorafenib therapy extends the interval to subsequent TACE for patients with unresectable hepatocellular carcinoma. J Surg Oncol,2016,26（6）:64-64.
[7] 郭斌,吴增城,张宪光,等. 肝动脉栓塞化疗治疗肝癌的应用进展. 中华肝胆外科杂志,2016,22（2）：137-141.
[8] 童玉云,张磊,王家平,等. 多西他赛联合碘化油TACE治疗原发性肝癌的应用. 昆明医科大学学报,2016,37（3）：60-66.
[9] 黄德佳.经肝动脉无水酒精碘化油混合乳剂栓塞治疗中晚期肝癌的基础与临床研究. 广西医科大学,2009.
[10] Cui L,Liu XX,Jiang Y,et al. Comparative study on transcatheter arterial chemoembolization,portal vein embolization and high intensity focused ultrasound sequential therapy for patients. Asia Pacif J Cancer Prevent,2012,13（12）:6257-6261.
[11] 许涛,景红霞,李林均,等. TACE、IMRT、HIFU联合DC-CIK治疗局部晚期原发性肝癌的效果. 广东医学,2016,37（12）：1846-1849.
[12] 肖潇,杨均,颜綦先,等. TACE治疗53例Child C级肝硬化并发小肝癌患者疗效评价. 实用肝脏病杂志,2016,19（2）：204-207.
[13] 程光荣,郭丽萍. 肝癌患者接受肝动脉灌注化疗栓塞术后护理康复效果分析. 实用肝脏病杂志,2016,19（6）：700-703.
[14] 王瑜,马宽生. 肝脏肿瘤局部消融技术的选择. 肝胆外科杂志,2013,21（1）：4-5.
[15] 朱晓黎,沈健. 局部消融在肝细胞癌治疗中的应用. 临床肝胆病杂志,2016,32（1）：56-61.
[16] 沈立杰,严鹏,张娟娜,等. CT引导下氩氦冷冻、射频消融和微波消融治疗肝癌的疗效对比.医学影像学杂志,2015,25（10）：1836-1839.
[17] 王晓维,付守忠,戴锋,等. 肝动脉栓塞化疗联合射频消融与联合微波消融治疗原发性肝癌的疗效和安全性比较.介入放射学杂志,2016,25（8）：673-676.
[18] Wright A S,Sampson L A,Warner T F,et al. Radiofrequency versus microwave ablation in a hepatic porcine model. Radiology,2005,236（1）:132-139.
[19] 赵鹏,郑加生,张洪海,等. 肝动脉导管化疗栓塞联合CT引导精准微波消融治疗原发性肝癌的疗效及影响因素.中华肿瘤杂志,2016,38（2）：138-145.
[20] 李海,游红勇,陈智敏,等. 经肝动脉化疗栓塞联合射频消融治疗乙肝相关原发性肝癌的疗效及其对α-L-岩藻糖苷酶及免疫功能的影响. 免疫学杂志,2015,31（11）：973-977.