早期序贯RFA结合TACE治疗合并乙型肝炎肝硬化的大肝癌患者临床观察

陈彬　李德周

[摘要] 目的 探讨早期序贯RFA结合TACE治疗合并乙型肝炎肝硬化的大肝癌患者的效果。 方法 选取我院2010年1月～2014年1月在我院就诊，符合本研究纳入标准的合并乙型肝炎肝硬化的大肝癌患者80例为研究对象，随机分为对照组和观察组，所有患者在保肝止痛的基础上给予TACE治疗，对照组患者治疗后10 d内完成RFA治疗，观察组患者在行TACE治疗后1个月内完成序贯RFA治疗。检测CD3+、CD4+和CD8+表达情况，在术前和术后6个月进行疗效判定，记录两组患者的血常规、肝功、肾功、凝血功能和不适症状的发生情况。 结果 观察组患者的AFP水平显著降低，且明显低于同期的对照组，但ECOG评分和Child-Pugh分级（A/B）差异无统计学意义（P>0.05）。两组患者的CD3+CD4+ T和CD4+/CD8+ T比例均升高，CD3+CD8+ T比例均下降，但观察组的改善情况明显优于同期的对照组，差异具有统计学意义（P<0.05）。两组患者发生恶心呕吐、发烧，心肌酶升高，转氨酶升高和TBil升高的比例差异无统计学意义（P>0.05），经过相应治疗后，不适症状在2周内消失。观察组临床有效率显著高于对照组，差异具有统计学意义（P<0.05）。 结论 采用早期序贯RFA结合TACE是一种针对合并乙型肝炎肝硬化的大肝癌的有效治疗措施，可以提高患者肿瘤控制率，延长患者的生存期，值得临床推广。

[关键词] 早期序贯；射频消融术；肝动脉化疗栓塞术；伴乙型肝炎肝硬化的大肝癌

[中图分类号] R735.7 [文献标识码] B [文章编号] 1673-9701（2016）16-0088-04

[Abstract] Objective To explore the effect of early sequential RFA combined with TACE in the treatment of patients with cirrhosis of liver cirrhosis. Methods Selected 80 patients with hepatitis B cirrhosis large liver cancer from January 2010 to January 2014 in our hospital， this study included in the standard combination as the research objects， they were randomly divided into control group and observation group. All patients treated with TACE treatment on the basis of protecting liver pain， within 10 days after the treatment of patients in the control group completed RFA therapy， the observation group patients undergone transcatheter arterial chemoembolization in the treatment of 1 month after complete RFA. The CD3+， CD4+ and CD8+ expression in preoperative were detected and postoperative 6 months after treatment to determine efficacy， occurrence of two groups of patients with routine blood test， liver function and renal function， blood coagulation function and symptoms were recorded. Results The level of AFP in the observation group was significantly lower than that of the control group， but there was no difference between ECOG and Child-Pugh（A/B）， and it was not statistically significant（P>0.05）. The rate of CD3+CD4+T and CD4+/CD8+T of the two groups were increased， the proportion of CD3+CD8+T was decreased， but the change of the observation group was significantly higher than that of the control group at the same time， the difference was statistically significant（P<0.05）. The two groups of patients with nausea and vomiting， fever， myocardial enzymes and TBil increased the proportion of patients with no difference（P>0.05）， after the appropriate treatment， symptoms of discomfort disappeared in 2 weeks. The clinical efficiency of the observation group was significantly higher than that of the control group， the difference was statistically significant（P<0.05）. Conclusion RFA combined with TACE is an effective method for the treatment of large hepatocellular carcinoma with cirrhosis. It can improve the tumor control rate and prolong the survival time of patients. It is worthy of clinical promotion.

[Key words] Early sequential； Radio frequency ablation； Hepatic arterial chemoembolization； Large liver cancer with hepatitis B cirrhosis

原发性肝癌（primary liver cancer，PLC）的发病率高，恶化速度快，进展迅速，据相关资料显示，2008年全球新增的肝癌患者达到75万，而死亡率高达93.33%，已严重威胁到人类的生命安全[1]。在我国，超过80%的PLC患者存在肝硬化现象，而约60%的肝硬化患者伴有乙型肝炎，导致75%～80%的患者不能进行手术切除而失去最佳治疗方案。因此非手术方法受到临床的广泛关注，常规的放化疗对肝癌细胞的损伤率极低，且会导致严重的并发症，降低患者的生存质量[2，3]。射频……