肝动脉化疗栓塞术联合超声引导下微波消融术治疗孤立性尾状叶肝细胞癌的疗效分析

摘要/Abstract

摘要： 目的分析经导管肝动脉化疗栓塞术(TACE) 联合超声引导下微波消融术 (MWA)治疗孤立性尾状叶肝细胞癌(HCC)的疗效。方法回顾性收集2015年1月至2022年1月于乐山市人民医院接受治疗的孤立性尾状叶 HCC 患者,共70例患者符合纳入标准,将其分为观察组(n=34,TACE联合MWA治疗) 与对照组(n=36 ,仅TACE治疗) 。记录并比较两组患者的临床资料、术后1个月的血清肿瘤标志物、肝功能指标、临床疗效、术后不良反应发生率以及2年总生存率(OS)。结果两组患者在年龄、性别、肿瘤直径、Child-Pugh 分级、是否伴有肝炎、肝硬化等临床资料比较,差异无统计学意义(均P>0.05)。术后一个月,观察组AFP、CEA、VEGF水平为(124.04±13.41) ng/mL,(3.69±1.47) ng/mL,(237.64±26.86) ng/L,高于对照组的(144.68±13.82) ng/mL,(3.48±1.44) ng/mL,(263.93±27.17) ng/L,其中AFP、VEGF水平组间差异有统计学意义(t=6.338、4.068,均P<0.05)。术后一个月,观察组总胆红素、白蛋白、丙氨酸氨基转移酶(ALT)水平为(18.55±1.93) μmol/L,(37.68±4.13 g/L,(44.36±4.19) U/L,低于对照组的(21.07±2.02) μmol/L,(36.39±5.90) g/L,(51.40±4.10) U/L,其中总胆红素和ALT水平组间差异有统计学意义(t=5.309、7.092,均P<0.05)。两组患者术后不良反应发生率比较,差异无统计学意义(均P>0.05)。术后1个月,观察组的客观缓解率为79.4% ,显著高于对照组的 55.6%(χ²=4.511,P<0.05)。术后2 年观察组的OS为70.6%,显著高于对照组的44.4%(χ²=4.880,P<0.05)。结论与单独使用TACE相比,TACE 联合MWA治疗孤立性尾状叶 HCC 可有效提高早期临床疗效及2年OS。

关键词: 经导管肝动脉化疗栓塞术, 肝癌, 消融

Abstract: Objective To evaluate the efficacy of transcatheter hepatic arterial chemoembolization (TACE) combined with ultrasound-guided microwave ablation (MWA) in the treatment of isolated caudate lobe hepatocellular carcinoma (HCC). Methods A retrospective analysis was conducted on 70 patients with isolated caudate lobe HCC who were treated at Leshan People's Hospital between January 2015 and January 2022. The patients were divided into an observation group (34 patients treated with TACE combined with MWA) and a control group (36 patients treated with TACE alone). Preoperative clinical data, one-month postoperative serum tumor markers, liver function indicators, clinical efficacy, incidence of postoperative adverse reactions, and 2-year overall survival (OS) rate were recorded and compared between the two groups. Results There was no statistically significant difference in preoperative clinical data such as age, gender, tumor diameter, Child-Pugh grade, presence of hepatitis, and cirrhosis between the two groups (all P>0.05). One month after surgery, the levels of serum tumor markers alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and vascular endothelial growth factor (VEGF) in the observation group were (124.04±13.41) ng/mL,(3.69±1.47) ng/mL, and (237.64±26.86) ng/L, respectively, which were lower than those in the control group [(144.68±13.82) ng/mL, (3.48±1.44) ng/mL, and (263.93±27.17) ng/L], respectively. Among them, the differences in AFP and VEGF levels between the two groups were statistically significant (t=6.338, 4.068, respectively, both P<0.05). One month after surgery, the liver function indicators of total bilirubin (TBil), albumin (Alb), and alanine aminotransferase (ALT) in the observation group were (18.55±1.93) μmol/L, (37.68±4.13) g/L, and (44.36±4.19) U/L, respectively, which were lower than those in the control group [(21.07±2.02) μmol/L, (36.39±5.90) g/L, and (51.40±4.10)U/L, respectively. Among them, the differences in TBil and ALT levels between the two groups were statistically significant (t=5.309, 7.092, respectively, both P<0.05). There was no statistically significant difference in the incidence of postoperative adverse reactions between the two groups (P>0.05). One month after surgery, the objective response rate in the observation group was 79.4%, significantly higher than that in the control group (55.6%) (χ²=4.511, P<0.05). Two years after surgery, the OS rate in the observation group was 70.6%, significantly higher than that in the control group (44.4%) (χ²=4.880, P<0.05). Conclusion Compared with TACE alone, TACE combined with MWA for the treatment of isolated caudate lobe HCC can effectively improve early clinical efficacy and two-year OS.

Key words: Transcatheter hepatic arterial chemoembolization, Liver cancer, Ablation

李英杰, 丁斌, 陈姗姗, 董程. 肝动脉化疗栓塞术联合超声引导下微波消融术治疗孤立性尾状叶肝细胞癌的疗效分析[J]. 肝脏, 2026, 31(2): 215-219.

LI Ying-jie, DING Bin, CHEN Shan-shan, DONG Cheng. Analysis of the efficacy of hepatic artery chemoembolization combined with ultrasound-guided microwave ablation in the treatment of solitary caudate lobe hepatocellular carcinoma[J]. Chinese Hepatolgy, 2026, 31(2): 215-219.

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