肝动脉栓塞联合射频消融间隔时间对小肝癌临床疗效的影响

孙玉; 张洪海; 龙江; 生守鹏; 郑加生; 张永宏

doi:10.3969/j.issn.1001-5256.2022.10.016

肝动脉栓塞联合射频消融间隔时间对小肝癌临床疗效的影响

DOI: 10.3969/j.issn.1001-5256.2022.10.016

首都医科大学附属北京佑安医院肝病与肿瘤介入治疗中心，北京 100069

基金项目:

北京市属医院科研培育计划 (PX2022067);

北京市自然科学基金重点项目 (7191004);

传染病相关疾病生物标志物北京市重点实验室 (BZ0373)

伦理学声明：本研究方案于2018年5月21日经由北京佑安医院伦理委员会审批，批号：京佑科伦字[2018]017号，所纳入患者均签署知情同意书。

利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。

作者贡献声明：张永宏、孙玉负责课题设计；孙玉、张洪海负责病例入组，资料分析，撰写论文；龙江、生守鹏负责病例入组，收集和分析数据；张永宏、郑加生负责指导撰写文章，修改文章并最后定稿。

详细信息

通信作者:
张永宏, 13810108505@163.com

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出版历程
- 收稿日期: 2022-03-02
- 录用日期: 2022-04-05
- 出版日期: 2022-10-20

Influence of the interval between transcatheter arterial embolization and radiofrequency ablation on the treatment outcome of small hepatocellular carcinoma

Center of Interventional Oncology and Liver Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China

Research funding:

Scientific Research and Cultivation Plan of Beijing Municipal Hospitals (PX2022067);

Natural Science Foundation of Beijing Municipality (7191004);

Beijing Key Laboratory of Biomarkers for Infectious Diseases (BZ0373)

More Information

Corresponding author: ZHANG Yonghong, 13810108505@163.com(ORCID: 0000-0002-1357-7891)

摘要

摘要: 目的研究肝动脉栓塞联合射频消融两种治疗时间间隔对小肝癌临床疗效的影响。方法选取2019年1月—2020年6月于首都医科大学附属北京佑安医院接受治疗的肝细胞癌患者70例。采用随机数字表法将患者分为观察组(肝动脉栓塞治疗当日或第2日序贯射频消融)和对照组(肝动脉栓塞治疗后1~2周序贯射频消融)，每组各35例。计量资料两组间比较采用独立样本t检验，术前与术后观察指标比较采用配对t检验；计数资料两组间比较采用χ²检验。结果观察组住院时间短于对照组，差异有统计学意义[(7.80±2.76) d vs (14.31±2.19) d，t=-10.93，P＜0.001}。观察组与对照组完全消融率(95.12% vs 95.00%，χ² =0.001，P=0.980)、不良反应发生率(25.71% vs 20.00%，χ² =0.324，P=0.569)及1年复发率(11.43% vs 14.29%，χ² =0.128，P=0.721)比较，差异均无统计学意义。对照组术前术后实验室指标与观察组术前术后比较，差异均无统计学意义(P值均＞0.05)。结论肝动脉栓塞短期序贯射频消融治疗小肝癌安全有效，可明显缩短患者住院时间，减少住院花费，值得临床推广。
- 癌, 肝细胞 /
- 栓塞, 治疗性 /
- 局部消融术 /
- 治疗结果
Abstract: Objective To investigate the influence of the interval between transcatheter arterial embolization (TAE) and radiofrequency ablation on the treatment outcome of small hepatocellular carcinoma. Methods A total of 70 patients with hepatocellular carcinoma who received treatment in Beijing YouAn Hospital, Capital Medical University, from January 2019 to June 2020 were enrolled and divided into observation group (radiofrequency ablation was performed on the day or the second day of TAE) and control group (radiofrequency ablation was performed at 1-2 weeks after TAE) using a random number table, with 35 patients in each group. The independent samples t-test was used for comparison of continuous data between two groups, and the paired t-test was used for comparison of observation indicators before and after surgery; the chi-square test was used for comparison of categorical data between two groups. Results The observation group had a significantly shorter length of hospital stay than the control group (7.80±2.76 days vs 14.31±2.19 days, t=-10.93, P < 0.001). There were no significant differences between the observation group and the control group in complete ablation rate (95.12% vs 95.00%, χ²=0.001, P=0.980), incidence rate of adverse reactions (25.71% vs 20.00%, χ²=0.324, P=0.569), and 1-year recurrence rate (11.43% vs 14.29%, χ²=0.128, P=0.721), and there were also no significant differences in laboratory markers between the two groups before and after treatment (all P > 0.05). Conclusion TAE combined with sequential radiofrequency ablation at a short interval is safe and effective in the treatment of small hepatocellular carcinoma and can significantly shorten the length of hospital stay and reduce hospital costs, and therefore, it holds promise for clinical application.
- Carcinoma, Hepatocellular /
- Embolization, Therapeutic /
- Local Ablation /
- Treatment Outcome

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表 1 两组患者基线资料比较

Table 1. Comparison of baseline data between the two groups

指标	观察组(n=35)	对照组(n=35)	统计值	P值
男/女(例)	28/7	26/9	χ²=0.32	0.57
年龄(岁)	56.43±9.33	53.74±10.58	t=1.13	0.26
WBC(×10⁹/L)	5.58±1.54	5.41±1.90	t=0.41	0.68
PLT(×10⁹/L)	143.03±46.68	145.74±56.92	t=-0.22	0.83
Hb(g/L)	133.80±18.44	135.34±17.49	t=-0.36	0.72
ALT(U/L)	34.38±13.39	35.55±16.87	t=-0.32	0.75
AST(U/L)	39.23±16.37	40.62±20.68	t=-0.31	0.76
Alb(g/L)	39.07±4.38	39.80±4.54	t=-0.69	0.50
TBil(μmol/L)	19.29±6.33	18.03±8.61	t=0.70	0.49
ChE (U/L)	5 719.74±1 456.05	5 834.86±1 530.94	t=-0.32	0.75
PT(s)	11.94±1.31	12.01±1.14	t=-0.23	0.82
AFP(例)			χ²=0.47	0.73
≤200 ng/mL	31	29
＞200 ng/mL	4	6
肿瘤最大直径(mm)	20.11±5.20	20.77±5.02	t=-0.54	0.59
肿瘤数目(例)			χ²=0.11	0.74
1个	29	30
2个	6	5
肿瘤部位(例)			χ²=0.07	0.79
右叶	26	25
左叶	9	10

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表 2 两组患者治疗前后实验室指标比较

Table 2. Comparison of laboratory indexes between the two groups before and after treatment

指标	观察组(n=35)				对照组(n=35)
指标	术前	术后3 d	t值	P值	术前	术后3 d	t值	P值
WBC(×10⁹/L)	5.58±1.54	6.18±1.61	-3.08	0.004	5.41±1.90	6.08±1.85	-4.489	＜0.001
PLT(×10⁹/L)	143.03±46.68	142.00±48.19	0.83	0.413	145.74±56.92	144.11±57.56	1.934	0.062
Hb(g/L)	133.80±18.44	132.77±16.45	1.62	0.116	135.34±17.49	134.57±18.37	1.487	0.146
ALT(U/L)	34.38±13.39	67.98±19.45	-10.52	＜0.001	35.55±16.87	66.80±23.75	-17.725	＜0.001
AST(U/L)	39.23±16.37	71.54±19.37	-11.56	＜0.001	40.62±20.68	72.03±17.92	-10.223	＜0.001
Alb(g/L)	39.07±4.38	37.34±3.99	7.53	＜0.001	39.80±4.54	38.02±4.69	10.151	＜0.001
TBil(μmol/L)	19.29±6.33	23.15±10.26	-3.20	0.003	18.03±8.61	23.33±12.13	-6.522	＜0.001
ChE(U/L)	5 719.74±1 456.05	5 601.4±1 671.43	1.052	0.300	5 834.86±1 530.94	5 808.49±1 524.91	1.586	0.122
PT(s)	11.94±1.31	12.16±1.28	-1.711	0.096	12.01±1.14	12.17±0.77	-0.956	0.346

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