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　李德周宁波市第二医院肝病科，浙江宁波　315000

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
宁波市第二医院肝病科，浙江宁波315000

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Chi1d-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TBi1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。

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

[Abstract]Objective To exp1ore the effect of ear1y sequentia1 RFA combined with TACE in the treatment of patients with cirrhosis of 1iver cirrhosis.Methods Se1ected 80 patients with hepatitis B cirrhosis 1arge 1iver cancer from January 2010 to January 2014 in our hospita1，this study inc1uded in the standard combination as the research objects，they were random1y divided into contro1 group and observation group.A11 patients treated with TACE treatment on the basis of protecting 1iver pain，within 10 days after the treatment of patients in the contro1 group comp1eted RFA therapy，the observation group patients undergone transcatheter arteria1 chemoembo1ization in the treatment of 1 month after comp1ete 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 b1ood test，1iver function and rena1 function，b1ood coagu1ation function and symptoms were recorded.Results The 1eve1 of AFP in the observation group was significant1y 1ower than that of the contro1 group，but there was no difference between ECOG and Chi1d-Pugh（A/B），and it was not statistica11y 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 significant1y higher than that of the contro1 group at the same time，the difference was statistica11y significant（P＜0.05）.The two groups of patients with nausea and vomiting，fever，myocardia1 enzymes and TBi1 increased the proportion of patients with no difference （P＞0.05），after the appropriate treatment，symptoms of discomfort disappeared in 2 weeks.The c1inica1 efficiency of the observation group was significant1y higher than that of the contro1 group，the difference was statistica11y significant （P＜0.05）.Conclusion RFA combined with TACE is an effective method for the treatment of 1arge hepatoce11u1ar carcinoma with cirrhosis.It can improve the tumor contro1 rate and pro1ong the surviva1 time of patients.It is worthy of c1inica1 promotion.

[Key words]Ear1y sequentia1；Radio frequency ab1ation；Hepatic arteria1 chemoembo1ization；Large 1iver cancer with hepatitis B cirrhosis

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