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