本文選題：經(jīng)導(dǎo)管肝動(dòng)脈化療栓塞 + 微波消融　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:通過對(duì)比觀察經(jīng)導(dǎo)管肝動(dòng)脈化療栓塞(TACE)聯(lián)合微波消融(MWA)與單純經(jīng)導(dǎo)管肝動(dòng)脈化療栓塞治療大肝癌的近期療效和不良反應(yīng),評(píng)價(jià)經(jīng)導(dǎo)管肝動(dòng)脈化療栓塞聯(lián)合微波消融在大肝癌治療中的近期臨床療效與安全性。方法:收集青島大學(xué)附屬醫(yī)院2013年1月1日至2014年11月30日就診的大肝癌患者68例,其中男61例,女7例,年齡38?74歲。根據(jù)治療方式不同,分為聯(lián)合組(36例)和對(duì)照組(32例),聯(lián)合組經(jīng)1?2次TACE治療后2?4周內(nèi)聯(lián)合MWA治療,對(duì)照組行2次以上TACE治療,兩組中AFP陽(yáng)性患者分別為31例(86.1%)和26例(81.3%)。術(shù)后1月、3月、6月復(fù)查,而后每3?6個(gè)月復(fù)查,包括CE-CT、CE-MRI、肝功、甲胎蛋白(AFP),觀察腫瘤大小、壞死情況及有無復(fù)發(fā)、轉(zhuǎn)移等情況。接受治療1個(gè)月后根據(jù)影像檢查評(píng)價(jià)兩組患者的近期療效。記錄不良反應(yīng)和并發(fā)癥發(fā)生情況、治療次數(shù)以及患者生存時(shí)間,通過統(tǒng)計(jì)學(xué)軟件進(jìn)行對(duì)比分析。結(jié)果:兩組患者在年齡、性別、Child-Pugh分級(jí)、病灶數(shù)目、最大長(zhǎng)徑、AFP陽(yáng)性率方面無明顯差異(P0.05)。聯(lián)合組及對(duì)照組分別平均治療3.6±1.2次、4.9±1.8次,兩組差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。聯(lián)合組CR 20例(55.6%)、PR 10例(27.8%)、SD 2例(5.6%)、PD 4例(11.1%)、RR 30例(83.3%),對(duì)照組CR 8例(25%)、PR 8例(25%)、SD 4例(12.5%)、PD 12例(37.5%)、RR 16例(50%),聯(lián)合組完全緩解率(CR)、疾病控制率(RR)及術(shù)后AFP轉(zhuǎn)陰率均明顯優(yōu)于對(duì)照組(P0.05)。聯(lián)合組與對(duì)照組的生存期分別為17.5±6.32個(gè)月和13.25±6.73個(gè)月,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。聯(lián)合組與對(duì)照組中位生存期分別為19個(gè)月和12個(gè)月,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。聯(lián)合組在12、18、24月的患者生存率優(yōu)于對(duì)照組(P0.05)。聯(lián)合組肩胛部酸痛、肝區(qū)疼痛的發(fā)生率明顯高于對(duì)照組(P0.05),兩組患者低熱等不良反應(yīng)和嚴(yán)重并發(fā)癥的發(fā)生率無明顯差異(P0.05)。兩組均未出現(xiàn)術(shù)中死亡病例。結(jié)論:TACE聯(lián)合MWA治療大肝癌較單純TACE治療手術(shù)次數(shù)減少,創(chuàng)傷小,近期療效確切,安全性高,是大肝癌的有效治療模式,具有臨床推廣價(jià)值。
[Abstract]:Objective: to observe the short-term efficacy and adverse reactions of transcatheter hepatic arterial chemoembolization (TACEE) combined with microwave ablation (MWA) and transcatheter arterial chemoembolization (TACE) in the treatment of large hepatocellular carcinoma (HCC). To evaluate the efficacy and safety of transcatheter hepatic arterial chemoembolization (TACE) combined with microwave ablation in the treatment of large liver cancer. Methods: a total of 68 patients with large liver cancer from January 1, 2013 to November 30, 2014, including 61 males and 7 females, aged 38 to 74 years, were collected from affiliated Hospital of Qingdao University. According to the different ways of treatment, they were divided into two groups: the combined group (36 cases) and the control group (32 cases). The combined group was treated with MWA within 2 weeks after two TACE treatments. The control group received more than 2 times of TACE treatment. 31 cases of AFP positive patients in the two groups were treated with TACE. 1 month, 3 months, 6 months after operation, then every 36 months, including CE-CTT CE-MRI, liver function, AFP, tumor size, necrosis, recurrence, metastasis and so on. One month after treatment, the short-term efficacy of the two groups was evaluated according to imaging examination. Adverse reactions and complications, times of treatment and survival time of patients were recorded and analyzed by statistical software. Results: there was no significant difference in age, sex, Child-Pugh grade, number of lesions and AFP positive rate of the maximum length of diameter between the two groups (P 0.05). The combined group and the control group were treated with an average of 3.6 鹵1.2 times and 4.9 鹵1.8 times, respectively. The difference between the two groups was statistically significant (P 0.05). In the combined group, there were 20 cases of PR with 55.6% PR and 2 cases of SD with SD of 5.66%. In the combined group, the complete remission rate, the disease control rate and the AFP negative conversion rate in the combined group were significantly higher than those in the control group (P 0.05) and the control group (n = 8). The total remission rate, the disease control rate and the AFP negative conversion rate in the combined group were significantly higher than those in the control group (P 0.05). The survival time of the combined group and the control group was 17.5 鹵6.32 months and 13.25 鹵6.73 months, respectively. The difference was statistically significant (P 0.05). The median survival time of the combined group and the control group was 19 months and 12 months, respectively. The difference was statistically significant (P 0.05). The survival rate of the combined group was better than that of the control group at 12 and 24 months (P 0.05). The incidence of scapular pain and liver pain in the combined group was significantly higher than that in the control group (P 0.05). There was no significant difference in the incidence of adverse reactions such as low fever and serious complications between the two groups. There were no cases of intraoperative death in both groups. Conclusion compared with TACE alone, the treatment of large liver cancer with MWA combined with 10% TACE has fewer surgical procedures, less trauma, better short-term curative effect and higher safety. It is an effective treatment mode for large liver cancer and has the value of clinical popularization.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.7

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