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目的分析超选择性肝肿瘤供血动脉化疗栓塞术(S-TACE)联合肝区局部高频深部热疗治疗原发性肝癌(HCC)的疗效。方法选取延边大学附属医院2012年1月至2014年2月收治的50例病灶>5 cm的原发性HCC患者,分成对照组(A组)和治疗组(B组),每组各25例,A组采用单纯S-TACE治疗,B组采用S-TACE联合肝区高频深部热疗治疗。检测术前和术后不同时间段肝功能、s IL-2R、VEGF、IL-6、COX-2,记录术后不良反应(发热、恶心、呕吐、腹胀、疼痛等)以及KPS评分,并随访生存期。结果与治疗前比较,肝功能指标AST、ALT、TBIL和DBIL在A组患者治疗后第1周明显升高(P<0.05),B组治疗后第1周虽有升高,但差异无统计学意义(P>0.05);两组术后第4周KPS评分升高,但仅B组有统计学差异(P<0.05);两组治疗后第1周和第4周血清VEGF及SIL-2R的含量均下降(P<0.05);两组IL-6水平在治疗后第1周和第4周下降(P<0.05);A组术后第4周COX-2表达增强(P<0.05),B组术后第4周后弱表达,甚至比治疗前更低,无统计学差异(P>0.05)。与治疗后第1周比较,两组治疗后第4周IL-6水平均下降(P<0.05),治疗后第4周A组血清VEGF和s IL-2R含量升高(P<0.05),而B组中两者术后第4周下降(P<0.05)。与A组比较,B组术后副反应发生率低(P<0.05)。B组的2年生存率较A组高,有统计学差异(P<0.05)。结论 S-TACE联合热疗可提高HCC患者KPS评分,降低不良反应,改善生存质量和延长生存期。血清SIL-2R、VEGF、IL-6及组织中COX-2变化可能与HCC患者的治疗效果相关。
Objective To analyze the curative effect of super selective hepatic tumor feeding artery chemoembolization (S-TACE) combined with local high frequency deep hyperthermia in the treatment of primary liver cancer (HCC). Methods Fifty primary HCC patients with lesions of> 5 cm admitted to the Affiliated Hospital of Yanbian University from January 2012 to February 2014 were divided into control group (group A) and treatment group (group B), with 25 cases in each group , Group A was treated with simple S-TACE, and group B was treated with S-TACE combined with high frequency deep hyperthermia in the liver region. The changes of liver function, sIL-2R, VEGF, IL-6 and COX-2 in preoperative and postoperative period were recorded and the postoperative adverse reactions (fever, nausea, vomiting, bloating and pain) and KPS scores were recorded and followed up Survival. Results Compared with those before treatment, AST, ALT, TBIL and DBIL of liver function were significantly increased in the first week after treatment in group A (P <0.05), while in the first week after treatment, the difference was not statistically significant (P> 0.05). KPS score increased at the 4th week after operation in both groups, but only in group B (P <0.05). Serum VEGF and SIL- (P <0.05). The levels of IL-6 in both groups decreased at the first week and the fourth week after treatment (P <0.05), and the expression of COX-2 increased in the fourth week after operation ), The weak expression in group B after 4 weeks, even lower than before treatment, no statistical difference (P> 0.05). Compared with the first week after treatment, the levels of IL-6 in both groups decreased after 4 weeks of treatment (P <0.05), and the levels of VEGF and s IL-2R in group A increased 4 weeks after treatment (P <0.05) However, both of the two groups decreased in the fourth week after operation (P <0.05). Compared with group A, the incidence of postoperative side effects in group B was lower (P <0.05). The 2-year survival rate of group B was higher than that of group A (P <0.05). Conclusion S-TACE combined with hyperthermia can improve KPS scores, reduce adverse reactions, improve quality of life and prolong survival in HCC patients. Changes of serum SIL-2R, VEGF, IL-6 and tissue COX-2 may be related to the therapeutic effect of HCC patients.