本文關(guān)鍵詞：HIFU聯(lián)合基因檢測指導(dǎo)下化療治療晚期胰腺癌的初步臨床觀察　出處：《重慶醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 胰腺癌 高強(qiáng)度聚焦超聲 基因檢測 化療

【摘要】：目的:通過臨床觀察分析高強(qiáng)度聚焦超聲(HIFU)聯(lián)合基因檢測指導(dǎo)化療治療晚期胰腺癌療效及其副反應(yīng),探討HIFU聯(lián)合基因檢測指導(dǎo)化療在晚期胰腺癌治療中的應(yīng)用價(jià)值。方法:21例符合納入標(biāo)準(zhǔn)的確診的晚期胰腺癌(III期3例,IV期18例)HIFU治療后均接受了化療。其中,8例化療是在基因檢測指導(dǎo)下選擇化療方案,13例則選擇傳統(tǒng)的胰腺癌一線化療方案,即分為基因檢測組(8例)和非基因檢測組(13例)。仔細(xì)觀察、記錄HIFU治療前后患者的副作用、血生化、疼痛變化,及化療的毒副反應(yīng),并采用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)分析,評價(jià)HIFU的療效及兩組患者間的差異。HIFU治療后2周采用增強(qiáng)MRI或CT對腫瘤消融情況進(jìn)行評估,并計(jì)算腫瘤消融百分比。隨訪所有患者的生存情況,采用Kaplan-Meier法進(jìn)行生存分析,并比較基因檢測組與非基因檢測組間的生存差異。結(jié)果:21例患者HIFU治療前腫瘤相關(guān)性疼痛(VAS視覺模擬量表,VAS)15例,HIFU治療后完全緩解3例(20.00%),部分緩解10例(66.67%),穩(wěn)定1例(6.67%),加重1例(6.67%),治療有效率為86.67%(完全緩解+部分緩解)。HIFU前后比較,治療后疼痛(VAS評分,4.62±3.67 vs 1.95±1.86)明顯緩解,且具有統(tǒng)計(jì)學(xué)意義(t檢驗(yàn),P=0.000);膽紅素、血糖無統(tǒng)計(jì)學(xué)意義(P0.05)。HIFU治療后腫瘤消融率平均為(90.58±6.91)%,且與患者生存顯著正相關(guān)(Peorson相關(guān)分析,P=0.013),基因檢測組與非基因檢測組腫瘤消融率差異無統(tǒng)計(jì)學(xué)意義(P=0.55)。21例患者平均隨訪8.19±6.10月,6月、12月生存率依次分別為42.9%、26.7%~33.3%,中位生存時(shí)間為6.00(95%CI=4.22~7.78)月,平均生存時(shí)間為9.92±1.91(95%CI=6.18~13.65)月�；驒z測組與非基因檢測組的6月、12月生存率依次分別為62.5%~75%vs 23.1%、41.7~62.5%vs 7.7%~15.4%,中位生存時(shí)間及平均生存時(shí)間依次分別為17.00(95%CI=1.58~32.42)月與5.00(95%CI=3.85~6.15)月、16.08±3.58(95%CI=9.07~23.10)月與5.70±1.01(95%CI=3.71~7.68)月,兩組比較,基因檢測組生存高于非基因檢測組,且具有統(tǒng)計(jì)學(xué)意義(Log Rank,P=0.015)。基因檢測組患者化療后按WHO分級標(biāo)準(zhǔn)無Ⅲ級和/或Ⅳ級毒副反應(yīng)發(fā)生,非基因檢測組中發(fā)現(xiàn)Ⅲ級毒副反應(yīng)7例(53.85%),兩組比較,其差異具有統(tǒng)計(jì)學(xué)意義(秩和檢驗(yàn),P=0.02)。結(jié)論:1.HIFU治療能顯著緩解晚期胰腺癌疼痛,是晚期胰腺癌姑息性治療的安全有效方法之一;2.HIFU聯(lián)合基因檢測指導(dǎo)下的化療治療晚期胰腺癌能延長患者生存期、降低化療后副反應(yīng),可能是晚期胰腺癌可供選擇的治療方案之一。
[Abstract]:Objective: To observe the efficacy and side effects of high intensity focused ultrasound (HIFU) combined with gene detection in guiding the treatment of advanced pancreatic cancer through clinical observation and analysis, and to explore the value of HIFU combined with gene detection in guiding the chemotherapy in the treatment of advanced pancreatic cancer. Methods: 21 patients with advanced pancreatic cancer (3 cases in III phase and 18 cases in IV phase) were treated with chemotherapy after HIFU treatment. Among them, 8 cases received chemotherapy under the guidance of gene detection, and 13 cases chose the traditional first-line chemotherapy plan for pancreatic cancer. They were divided into gene detection group (8 cases) and non gene detection group (13 cases). The side effects, blood biochemical and pain changes, and side effects of chemotherapy were carefully observed and recorded before and after HIFU treatment. Statistical analysis was performed by SPSS 19 software to evaluate the efficacy of HIFU and the difference between the two groups. 2 weeks after HIFU treatment, the tumor ablation was evaluated by enhanced MRI or CT, and the percentage of tumor ablation was calculated. The survival of all the patients was followed up by Kaplan-Meier, and the survival difference between the gene test group and the non gene test group was compared. Results: in 21 patients, there were 15 cases of tumor related pain (VAS visual analog scale, VAS) before HIFU treatment, 3 cases (20%) were completely relieved after HIFU treatment, 10 cases (66.67%) were partial remission, 1 cases (6.67%) were stable, 1 cases (6.67%) were aggravated, and the effective rate of treatment was 86.67% (complete relief + partial remission). After HIFU, pain after treatment (VAS score, 4.62 + 3.67 vs 1.95 + 1.86) was significantly relieved, with statistical significance (t test, P=0.000). Bilirubin and blood glucose were not statistically significant (P0.05). The average ablation rate of tumor after HIFU treatment was (90.58 + 6.91)%, which was significantly positively correlated with the survival of patients (Peorson correlation analysis, P=0.013). There was no significant difference in tumor ablation rate between gene detection group and non gene detection group (P=0.55). 21 patients were followed up for an average of 8.19 + 6.10 months. The survival rates in June and December were 42.9% and 26.7%~33.3%, respectively. The median survival time was 6 (95%CI=4.22~7.78) months, with an average survival time of 9.92 + 1.91 (95%CI=6.18~13.65) months. Detection of gene group and gene detection group in June, December respectively. The survival rate of 62.5%~75%vs 23.1%, 41.7~62.5%vs 7.7%~15.4%, the median survival time and median survival time were 17 months (95%CI=1.58~32.42) and 5 (95%CI=3.85~6.15) months, 16.08 + 3.58 (95%CI=9.07~23.10) and 5.70 + 1.01 (95%CI=3.71~7.68) months, two group, genetic testing group survival was higher than that of non genetic testing group, and have statistical significance (Log, Rank, P=0.015). There was no grade III or / or IV toxicity in the gene detection group according to the WHO grading standard after chemotherapy. In the non gene detection group, there were 7 cases of grade III toxicity (53.85%). The difference between the two groups was statistically significant (rank sum test, P=0.02). Conclusion: 1.HIFU treatment can significantly relieve pain of advanced pancreatic cancer, is one of the safe and effective method for palliative treatment of advanced pancreatic cancer; chemotherapy in the treatment of advanced pancreatic cancer combined with detection of 2.HIFU gene under the guidance of can prolong survival and reduce the side effects of chemotherapy, may be one of the treatment options for advanced pancreatic cancer.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R735.9

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