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目的评价CT引导下经皮穿刺氩氦冷冻治疗对>60岁原发巨块型肝癌患者生活质量(QOL)的影响。方法本组91例,肿瘤直径10~14 cm,均为富血供。所有病例CT引导下实施肝脏病灶经皮穿刺氩氦冷冻治疗。分别于术前,术后1 w,1个月,3个月评价生活质量,复查肿瘤标志物、CT,评价肿瘤负荷变化。生活质量采用肝胆肿瘤治疗功能评定量表(FACT-Hep)评价QOL变化。结果随访期间88例患者完成所有时间点QOL调查量表。术后1 w身体状况(P=0.017)及功能状况(P<0.001)模块有较大幅度降低,情感状况较术前轻度改善(P=0.024),肝癌特异性模块无明显变化(P=0.665),社会/家庭状况则下降,差异有显著性意义(P<0.01)。术后1个月身体状况(P<0.001),功能状况(P<0.001),肝癌特异性模块得分(P<0.001)较术前明显上升,社会/家庭状况回复至术前状况(P>0.05),FACT-Hep总分开始高于术前水平(P<0.001)。术后3个月,除经济状况模块外(P>0.05),所有模块及FACT-Hep总分均较术前改善(P<0.001)。其中功能状态和情感状态最为明显。社会家庭状况较术后1个月时略有所下降,但差异无显著性意义(P>0.05)。结论经皮穿刺氩氦冷冻治疗巨块型肝癌,在短期内可提高老年患者生活质量。对巨块型HCC,经皮穿刺氩氦冷冻治疗对长期QOL及生存期的影响有待于进一步研究。
Objective To evaluate the effect of CT-guided percutaneous argon-helium cryo-cryotherapy on quality of life (QOL) in patients with primary massive liver cancer of> 60 years old. Methods 91 cases in this group, the tumor diameter of 10 ~ 14 cm, are rich blood supply. All cases of CT-guided implementation of liver lesions percutaneous puncture argon-helium cryotherapy. The quality of life was evaluated preoperatively, 1 w, 1 month, and 3 months after operation, and the tumor markers and CT were reviewed to evaluate the changes of tumor burden. Quality of Life The QOL changes were evaluated using the FACT-Hep. Results During follow-up, 88 patients completed the QOL survey at all time points. There was a significant decrease in the physical status (P = 0.017) and functional status (P <0.001) at 1 w after operation, with a slight improvement in emotional status (P = 0.024) and no significant change in specific modules of hepatocellular carcinoma (P = 0.665), while the social / family status decreased with a significant difference (P <0.01). The functional status (P <0.001) and the specific module of hepatocellular carcinoma (P <0.001) at 1 month after operation were significantly higher than those before operation (P <0.001), and the social / family status returned to the preoperative status ), The FACT-Hep score began to be higher than the preoperative level (P <0.001). At 3 months after operation, the total score of all the modules and FACT-Hep was improved compared with that before operation (P <0.001) except for the economic status module (P> 0.05). Among them, the functional status and emotional status are the most obvious. The social family status declined slightly compared with one month after the operation, but the difference was not significant (P> 0.05). Conclusion Percutaneous argon-helium cryoablation of giant hepatocellular carcinoma can improve the quality of life of elderly patients in a short period of time. For bulky HCC, percutaneous argon-helium cryotherapy on long-term QOL and survival needs further study.