经导管动脉化疗栓塞术联合高强度聚焦超声在原发性巨块型肝癌合并门脉癌栓治疗中的疗效评估

Evaluation of efficacy of transcatheter arterial chemoembolization combined with high intensity focused ultrasound in the treatment of massive hepatocellular carcinoma complicated with portal vein tumor thrombosis

摘要:

目的：评估经导管动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）联合高强度聚焦超声（high intensity focused ultrasound，HIFU）治疗原发性巨块型肝癌（massive hepatocellular carcinoma，MHCC）合并门脉癌栓（portal vein tumor thrombosis，PVTT）的临床疗效。方法：回顾性分析重庆医科大学附属第二医院81例MHCC合并PVTT患者的临床资料，根据治疗方式，将其分为TACE+HIFU组（患者接受TACE联合HIFU治疗，41例）和TACE组（患者仅接受TACE治疗，40例）。评估2组患者肿瘤瘤体、PVTT治疗有效率，分析Karnofsky生存质量评分变化、术后不良反应、中位生存时间，以Pearson相关分析TACE术后行HIFU治疗的时间间隔与术后1个月生存质量评分的关系。结果：TACE+HIFU组肿瘤瘤体、PVTT治疗有效率（58.5%；48.8%）明显高于TACE组（20.0%；17.5%），2组差异有统计学意义（P=0.000、0.003）；TACE+HIFU组中位生存时间（8个月）较TACE组（4个月）延长（P=0.028）；TACE+HIFU组术后Karnofsky生存质量评分较术前提高，生存质量得到改善，并且优于TACE组术后评分（P=0.009）。2组患者在术后及随访期间均没有严重手术相关并发症出现。TACE术后行HIFU治疗的时间间隔与术后1个月生存质量评分呈低度负相关（r=-0.381，P=0.014）。结论：TACE+HIFU的联合治疗模式对MHCC合并PVTT患者可提高短期疗效，控制瘤体及PVTT进展，延缓生存时间，是一种安全有效的治疗手段。

Abstract:

Objective：To evaluate the short-term clinical efficacy of transcatheter arterial chemoembolization（TACE） combined with high intensity focused ultrasound（HIFU） in the treatment of massive hepatocellular carcinoma（MHCC） complicated with portal vein tumor thrombosis（PVTT）. Methods：A total of 81 patients with MHCC complicated with PVTT in the Second Affiliated Hospital of Chongqing Medical University were enrolled in this retrospective study. According to the treatment methods，they were divided into the TACE+HIFU group（41 patients，received TACE combined with HIFU） and the TACE group（40 patients，only received TACE）. The effective treatment rate was evaluated by comparing the imaging data of tumor lesions and PVTT in two groups，and the survival quality Karnofsky score，postoperative adverse reactions and median survival time were analyzed. Pearson correlation was used to analyze the relationship between time interval of HIFU treatment after TACE and Karnofsky score one month after op－eration. Results：The tumor lesion and PVTT effective rate in the TACE+HIFU group（58.5%；48.8%） was significantly higher than that in the TACE group（20.0%；17.5%），and the difference between the two groups was statistically significant（P=0.000，0.003）. The median survival time in the TACE+HIFU group was 8 months，which was longer than that in the TACE group（4 months）（P=0.028）. The Karnofsky score one month after operation in the TACE+HIFU group was higher than that before operation；the quality of life was improved，which was better than that in the TACE group（P=0.009）. There were no serious complications in both groups during the postoperative and follow-up period. The time interval of HIFU treatment after TACE showed a low negative correlation with Karnofsky score one month after operation（r=-0.381，P=0.014）. Conclusion：For patients with MHCC and PVTT，the pattern of TACE+HIFU is a safe and effective combination therapy，enhancing the short-term curative effect. It not only can prolong survival time，but also control the progression of the tumor lesion and PVTT at the same time.