TAE聯(lián)合HIFU治療早期肝癌的近期療效及復(fù)發(fā)的危險(xiǎn)因素
發(fā)布時(shí)間：2018-12-18 18:52
【摘要】：目的:探討肝動(dòng)脈栓塞術(shù)后聯(lián)合高強(qiáng)度聚焦超聲治療早期肝癌的近期療效,并明確哪些因素是其治療后復(fù)發(fā)的危險(xiǎn)因素。方法:選取2013年1月至2015年3月間重慶醫(yī)科大學(xué)附屬第二醫(yī)院HIFU中心收治的早期肝癌患者,共39例,TNM分期T1~2N0M0,所有患者均行1次TAE術(shù),術(shù)后間隔1-2周行1次HIFU治療。其中TAE采用重慶醫(yī)科大學(xué)附屬第二醫(yī)院藍(lán)盾介入中心常規(guī)方法,即從股動(dòng)脈插入導(dǎo)管,注入造影劑使血管顯影后,選擇性地將碘油栓塞劑注入腫瘤供血?jiǎng)用}中,使其血供中斷或減少以造成腫瘤組織缺血壞死。HIFU治療采用JC型聚焦超聲腫瘤治療系統(tǒng)(中國(guó)重慶海扶技術(shù)有限公司),在全麻下利用超聲實(shí)時(shí)監(jiān)控系統(tǒng)精確定位于肝癌病灶,通過(guò)聚焦超聲的熱效應(yīng)、空化效應(yīng)以及機(jī)械效應(yīng)殺滅腫瘤細(xì)胞。通過(guò)分析其臨床資料,包括年齡、腫瘤大小、腫瘤位置(是否鄰近大血管、膽囊窩及膈肌)、治療前白蛋白、HBV-DNA定量及治療前后血清甲胎蛋白(AFP)、治療后并發(fā)癥等,并通過(guò)治療前后及3月后復(fù)查的MRI顯示的腫瘤大小計(jì)算HIFU消融率及治療后3月腫瘤的縮小率,通過(guò)比較治療前后AFP變化、HIFU消融率、治療后并發(fā)癥、3月后腫瘤縮小率及復(fù)發(fā)時(shí)間,分析其療效及復(fù)發(fā)的危險(xiǎn)因素。其中治療前后資料的對(duì)比使用t檢驗(yàn),分類資料的比較采用Fisher確切概率法,多因素分析則構(gòu)建多因素logistic回歸模型。P0.05被認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。所有統(tǒng)計(jì)學(xué)分析懫用SPSS19.0軟件進(jìn)行。結(jié)果:(1)39例患者中,治療前血清AFP升高者于治療后有不同程度下降,治療后復(fù)查MRI可見(jiàn)原病灶內(nèi)明顯凝固性壞死區(qū),腫瘤消融率絕大部分可達(dá)90%以上,治療后3月復(fù)查MRI見(jiàn)絕大部分腫瘤有不同程度縮小。所有患者術(shù)后均未出現(xiàn)嚴(yán)重并發(fā)癥。(2)單因素分析發(fā)現(xiàn),腫瘤鄰近大血管或膽囊、膈肌及HBV-DNA定量1×103IU/ml的患者,1年內(nèi)復(fù)發(fā)幾率較高(p0.05),而不同年齡、腫瘤直徑、白蛋白、AFP水平與是否復(fù)發(fā)之間無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。多因素分析結(jié)果顯示,血清AFP水平及HBV-DNA定量與治療后復(fù)發(fā)相關(guān),p0.05,有統(tǒng)計(jì)學(xué)意義,其他因素與治療后是否復(fù)發(fā)無(wú)相關(guān)性(p0.05)。結(jié)論:TAE聯(lián)合HIFU治療早期肝癌是有效而可行的,且腫瘤位置(是否鄰近大血管、膽囊窩及膈肌)及HBV-DNA復(fù)制數(shù)是治療后復(fù)發(fā)的獨(dú)立危險(xiǎn)因素,而治療前血清AFP水平是復(fù)發(fā)的非獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to investigate the short-term efficacy of hepatic artery embolization combined with high intensity focused ultrasound (HIFU) in the treatment of early hepatocellular carcinoma (HCC) and to identify the risk factors for recurrence. Methods: from January 2013 to March 2015, 39 patients with early liver cancer were treated in HIFU Center of the second affiliated Hospital of Chongqing Medical University. All patients were treated with TAE once every 1-2 weeks after operation. Among them, TAE used the routine method of blue shield interventional center in the second affiliated Hospital of Chongqing Medical University, that is, inserting catheter from femoral artery, injecting contrast agent to make blood vessel development, then selectively injecting lipiodol embolization into tumor blood supply artery. The HIFU was treated with JC focused ultrasound tumor therapy system (China Chongqing Haifu Technology Co., Ltd.). Under general anesthesia, real-time ultrasound monitoring system was used to accurately locate the focus of liver cancer. The thermal, cavitation and mechanical effects of focused ultrasound were used to kill tumor cells. The clinical data, including age, tumor size, tumor location (adjacent to large blood vessels, gallbladder fossa and diaphragm), prealbumin, HBV-DNA quantification and complications after treatment with alpha-fetoprotein (AFP), were analyzed. The ablation rate of HIFU was calculated by MRI before and after treatment and 3 months after treatment. The changes of AFP, the ablation rate of HIFU, and the complications after treatment were compared before and after treatment. After 3 months, the reduction rate and recurrence time of tumor were analyzed, the curative effect and the risk factors of recurrence were analyzed. Among them, t test was used to compare the data before and after treatment, Fisher exact probability method was used to compare the classified data, and multivariate logistic regression model was constructed by multivariate analysis. P0.05 was considered to have statistical significance. All statistical analysis was performed with SPSS19.0 software. Results: (1) in 39 patients, the patients with elevated serum AFP decreased in varying degrees after treatment. After treatment, MRI showed obvious coagulative necrosis in the lesion, and the tumor ablation rate was more than 90%. 3 months after treatment, MRI showed that most of the tumors were reduced to varying degrees. No serious complications were found in all patients. (2) univariate analysis showed that patients with tumor adjacent to large vessels or gallbladder, diaphragm and HBV-DNA 1 脳 103IU/ml had a higher recurrence rate within one year (p0. 05), but at different ages. There was no significant correlation between tumor diameter, albumin, AFP levels and recurrence (p0. 05). The results of multivariate analysis showed that the level of serum AFP and the quantity of HBV-DNA were correlated with the recurrence after treatment (p0.05), while the other factors had no correlation with the recurrence after treatment (p0.05). Conclusion: TAE combined with HIFU is effective and feasible in the treatment of early hepatocellular carcinoma. The location of tumor (adjacent to large vessels, gallbladder fossa and diaphragm) and the number of HBV-DNA replication are independent risk factors for recurrence after treatment. Serum AFP level was an independent risk factor for recurrence before treatment.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.7
本文編號(hào)：2386340
[Abstract]:Objective: to investigate the short-term efficacy of hepatic artery embolization combined with high intensity focused ultrasound (HIFU) in the treatment of early hepatocellular carcinoma (HCC) and to identify the risk factors for recurrence. Methods: from January 2013 to March 2015, 39 patients with early liver cancer were treated in HIFU Center of the second affiliated Hospital of Chongqing Medical University. All patients were treated with TAE once every 1-2 weeks after operation. Among them, TAE used the routine method of blue shield interventional center in the second affiliated Hospital of Chongqing Medical University, that is, inserting catheter from femoral artery, injecting contrast agent to make blood vessel development, then selectively injecting lipiodol embolization into tumor blood supply artery. The HIFU was treated with JC focused ultrasound tumor therapy system (China Chongqing Haifu Technology Co., Ltd.). Under general anesthesia, real-time ultrasound monitoring system was used to accurately locate the focus of liver cancer. The thermal, cavitation and mechanical effects of focused ultrasound were used to kill tumor cells. The clinical data, including age, tumor size, tumor location (adjacent to large blood vessels, gallbladder fossa and diaphragm), prealbumin, HBV-DNA quantification and complications after treatment with alpha-fetoprotein (AFP), were analyzed. The ablation rate of HIFU was calculated by MRI before and after treatment and 3 months after treatment. The changes of AFP, the ablation rate of HIFU, and the complications after treatment were compared before and after treatment. After 3 months, the reduction rate and recurrence time of tumor were analyzed, the curative effect and the risk factors of recurrence were analyzed. Among them, t test was used to compare the data before and after treatment, Fisher exact probability method was used to compare the classified data, and multivariate logistic regression model was constructed by multivariate analysis. P0.05 was considered to have statistical significance. All statistical analysis was performed with SPSS19.0 software. Results: (1) in 39 patients, the patients with elevated serum AFP decreased in varying degrees after treatment. After treatment, MRI showed obvious coagulative necrosis in the lesion, and the tumor ablation rate was more than 90%. 3 months after treatment, MRI showed that most of the tumors were reduced to varying degrees. No serious complications were found in all patients. (2) univariate analysis showed that patients with tumor adjacent to large vessels or gallbladder, diaphragm and HBV-DNA 1 脳 103IU/ml had a higher recurrence rate within one year (p0. 05), but at different ages. There was no significant correlation between tumor diameter, albumin, AFP levels and recurrence (p0. 05). The results of multivariate analysis showed that the level of serum AFP and the quantity of HBV-DNA were correlated with the recurrence after treatment (p0.05), while the other factors had no correlation with the recurrence after treatment (p0.05). Conclusion: TAE combined with HIFU is effective and feasible in the treatment of early hepatocellular carcinoma. The location of tumor (adjacent to large vessels, gallbladder fossa and diaphragm) and the number of HBV-DNA replication are independent risk factors for recurrence after treatment. Serum AFP level was an independent risk factor for recurrence before treatment.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.7
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