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目的探索超声引导下不可逆性电穿孔对晚期肝癌的治疗效果。方法前瞻性收集2015年7月至2015年9月期间中国人民解放军火箭军总医院收治的8例晚期肝癌患者(共10个病灶),对其进行超声引导下经皮、腹腔镜或开腹直视下不可逆性电穿孔治疗,分析不可逆性电穿孔对肝癌的治疗效果。结果与治疗前比较,治疗后3个月患者的生活质量评分升高〔(37.75±4.65)分比(22.25±2.87)分,P=0.000〕,总胆红素(56.37 mmol/L比150.40 mmol/L,P=0.046)、直接胆红素(58.69 mmol/L比71.60 mmol/L,P=0.012)、谷丙转氨酶〔(52.63±12.14)U/m L比(87.28±27.94)U/m L,P=0.003〕、谷草转氨酶〔(48.45±13.75)U/m L比(74.40±21.09)U/m L,P=0.000〕及甲胎蛋白(82.10 ng/m L比159.20 ng/m L,P=0.042)水平均降低。治疗后1例患者出现上腹部持续疼痛,所有患者均未发生感染、胆瘘、出血、肝肾功能衰竭等严重并发症。术后3个月复查腹部增强CT或MRI检查示:7例肿瘤完全消融,1例肿瘤未完全消融,仍有部分残余。8例患者均获访,随访时间为3~5个月、(4.0±0.9)个月。随访期间所有患者均存活,1例复发。结论超声引导下不可逆性电穿孔对晚期肝癌的治疗疗效显著,具有良好的安全性和有效性,值得在临床中开展应用。
Objective To explore the therapeutic effect of ultrasound-guided irreversible electroporation on advanced liver cancer. Methods A total of 8 patients with advanced hepatocellular carcinoma (10 lesions) admitted to the Chinese PLA General Hospital of Rocket Army from July 2015 to September 2015 were prospectively collected. The patients underwent ultrasound-guided percutaneous, laparoscopic or open surgery Irreversible electrovaporization under the eye treatment, analysis of irreversible electroporation for the treatment of liver cancer. Results Compared with those before treatment, the quality of life scores were significantly higher at 3 months after treatment (37.75 ± 4.65 vs 22.25 ± 2.87, P = 0.000), total bilirubin (56.37 mmol / L vs 150.40 mmol /L,P=0.046), direct bilirubin (58.69 mmol / L vs 71.60 mmol / L, P = 0.012), alanine aminotransferase (52.63 ± 12.14) U / mL ratio (87.28 ± 27.94) U / m (48.45 ± 13.75) U / m L (74.40 ± 21.09) U / m L, P = 0.000] and AFP (82.10 ng / m L vs 159.20 ng / m L , P = 0.042) decreased. After treatment, one patient had persistent pain in the upper abdomen, and no serious complications such as infection, biliary fistula, hemorrhage and liver and kidney failure occurred in all patients. 3 months after the review of abdominal enhanced CT or MRI showed: 7 cases of complete ablation of the tumor, 1 case of tumor is not completely ablated, there are still some residual. All 8 patients were followed up for 3 to 5 months (4.0 ± 0.9) months. All patients survived during follow-up, and one patient relapsed. Conclusion Ultrasound-guided irreversible electroporation has a significant effect on the treatment of advanced liver cancer and has good safety and efficacy, which is worthy of clinical application.