發(fā)布時間：2018-05-02 12:21

  本文選題：TACE + PMCT�。� 參考：《西南醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過對比經(jīng)動脈導管灌注化療栓塞術(shù)(TACE)聯(lián)合微波消融術(shù)(PMCT)與單純TACE處理前后血清血管內(nèi)皮生長因子(VEGF)、血清甲胎蛋白(AFP)、肝癌患者肝儲備功能的變化情況以及治療后病灶控制率、并發(fā)癥,探討TACE聯(lián)合PMCT治療肝惡性腫瘤的優(yōu)勢;并通過比較兩組患者治療前后T淋巴細胞亞群的變化,探討PMCT對患者機體免疫功能的影響。方法:將我科2016年1月至2017年1月符合本研究入組標準的肝癌病人共78例次,分為實驗組(TACE聯(lián)合PMCT組)和對照組(TACE組),其中實驗組36例,對照組42例;兩組患者均予以TACE以及常規(guī)護肝降酶、抗乙肝病毒等基礎(chǔ)治療,實驗組在TACE后5~7天進行PMCT,分別在TACE術(shù)前1天、TACE或PMCT術(shù)后5天抽取外周血測量血清VEGF、AFP水平以及肝儲備功能即ICG R15(吲哚菁綠試驗15min滯留率)以及T淋巴細胞亞群的變化;術(shù)后觀察兩組病人并發(fā)癥情況;術(shù)后1月復查AFP水平并行增強CT或MRI檢查,評估病灶的控制率(完全緩解+部分緩解+疾病穩(wěn)定)。結(jié)果:1、對照組TACE治療后血清VEGF濃度較治療前明顯升高,差異具有統(tǒng)計學意義(P0.05);實驗組TACE聯(lián)合PMCT治療后血清VEGF濃度較治療前明顯下降,差異具有統(tǒng)計學意義(P0.05)。2、對照組42例患者中30例術(shù)前AFP水平升高的患者,術(shù)后1月復查AFP均有不同程度降低,其中4例(4/30,13.3%)患者恢復正常,12例(12/30,40.0%)患者下降≥50%;實驗組36例患者中25例AFP水平升高的患者,術(shù)后1月復查AFP,均有不同程度降低,其中7例(7/25,28.0%)患者恢復正常,13例(13/25,52.0%)患者下降≥50%。實驗組經(jīng)治療后AFP下降率明顯優(yōu)于對照組,差異具有統(tǒng)計學意義(P0.05)。3、對照組TACE治療后肝儲備功能吲哚菁綠15分鐘滯留率(ICG R15)較治療前明顯升高,差異具有統(tǒng)計學意義(P0.05)。實驗組TACE聯(lián)合PMCT治療后肝儲備功能吲哚菁綠15分鐘滯留率(ICG R15)較前降低,差異具有統(tǒng)計學意義(P0.05)。4、對照組患者TACE治療后CD3+T細胞、CD4+T細胞水平及CD4+/CD8+比值均明顯下降,CD8+T細胞水平較治療前升高,差異具有統(tǒng)計學意義(P0.05);實驗組患者TACE聯(lián)合PMCT治療后CD3+T細胞、CD4+T細胞水平及CD4+/CD8+比值均下降,CD8+T細胞水平較治療前升高,但差異無統(tǒng)計學意義(P0.05)。5、病灶控制率對比:根據(jù)世界衛(wèi)生組織(WHO)實體瘤測量標準進行評價病灶控制率(完全緩解+部分緩解+疾病穩(wěn)定),其中實驗組CR 7例,PR14例,SD 12例,PD 3例,控制率為91.7%(33/36);對照組CR 4例,PR 13例,SD 14例,PD 11例,控制率為73.8%(31/42)。實驗組1月病灶控制率明顯高于對照組,差異有統(tǒng)計學意義(P0.05)。6、兩組患者除有惡心、嘔吐、發(fā)熱、疼痛等常見并發(fā)癥外,兩組各出現(xiàn)1例嚴重并發(fā)癥,對照組中出現(xiàn)1例(1/42,2.4%)膽汁瘤;實驗組中出現(xiàn)1例(1/36,2.8%)膽道支氣管瘺,兩組間差異無統(tǒng)計學意義。結(jié)論:1、TACE治療會損害肝臟功能,PMCT治療對肝臟的功能影響不大;2、TACE治療對肝癌患者的細胞免疫具有一定的損害,而PMCT可在一定程度上提高患者細胞免疫;3、TACE與PMCT治療肝癌相互補充,二者聯(lián)合具有安全、實用、有效、優(yōu)勢互補的特點,可提高肝癌患者的療效,減少轉(zhuǎn)移和復發(fā),具有一定的臨床推廣價值。
[Abstract]:Objective: To compare the changes of serum vascular endothelial growth factor (VEGF), serum alpha fetoprotein (AFP) and liver reserve function in patients with liver cancer before and after transcatheter arterial catheter perfusion chemotherapy (TACE) combined with microwave ablation (PMCT) and simple TACE treatment, and the control rate and complications after treatment, and discuss the combination of TACE and PMCT in the treatment of liver malignancies. By comparing the changes of T lymphocyte subsets before and after treatment in two groups of patients, and to explore the effect of PMCT on the immune function of the patients. Methods: 78 cases of liver cancer patients who were in accordance with the standard of this study from January 2016 to January 2017 were divided into the experimental group (TACE combined PMCT group) and the control group (group TACE), of which 36 cases were in the experimental group, The control group had 42 cases; the two groups were treated with TACE, conventional liver protection, anti HBV and other basic treatments. The experimental group performed PMCT on 5~7 days after TACE. The serum VEGF, AFP level and ICG R15 (indocyanine green test 15min retention) and lymph fines were taken at 1 days before TACE and 5 days after TACE or PMCT respectively. Changes in the cell subgroup; after the operation, the complications were observed in two groups of patients. After the reexamination of AFP level in January and the CT or MRI examination, the control rate of the focus (complete remission + partial remission + disease stability). Results: 1, the serum VEGF concentration in the control group was significantly higher than before the treatment (P0.05); the experimental group TACE combined with TACE. The concentration of serum VEGF decreased significantly after treatment with PMCT, and the difference was statistically significant (P0.05).2. In the 42 patients in the control group, 30 cases with higher AFP level before operation were reduced in different degrees in January, of which 4 cases (4/30,13.3%) were restored to normal, 12 cases (12/30,40.0%) decreased more than 50%, and 2 of the 36 patients in the experimental group were 2. In 5 patients with elevated AFP level, AFP was reviewed in January, and 7 cases (7/25,28.0%) were restored to normal, and 13 cases (13/25,52.0%) were significantly better than the control group after treatment. The difference was statistically significant (P0.05).3, and the liver reserve function of indocyanine green 15 after TACE treatment in the control group. The rate of clock retention (ICG R15) was significantly higher than that before the treatment (P0.05). The 15 minute retention rate of indocyanine green (ICG R15) after TACE combined with PMCT in the experimental group was lower than that before, and the difference was statistically significant (P0.05).4. The CD3+T cells in the control group were treated with TACE, and the CD4+T cell level and the ratio were all clear. The level of CD8+T cell was significantly higher than that before the treatment (P0.05). The level of CD3+T cells, CD4+T cell level and CD4+/CD8+ ratio decreased after TACE combined with PMCT in the experimental group, and the level of CD8+T cells was higher than that before the treatment, but the difference was not statistically significant (P0.05).5, the control rate of the lesion was compared: according to WHO (WHO) Solid tumor measurement standard was used to evaluate the control rate of focus (complete remission + partial remission + disease stability). In the experimental group, CR 7 cases, PR14 cases, SD 12 cases, PD 3 cases, control rate 91.7% (33/36), control group CR 4 cases, PR 13 cases, SD 14 cases, PD 11 cases, and the control rate is 73.8% (31/42). In the experiment group in January, the focus control rate was obviously higher than the control group, the difference has statistics Learning significance (P0.05).6, two groups of patients, except for nausea, vomiting, fever, pain and other common complications, the two groups of 1 cases of severe complications, 1 cases in the control group (1/42,2.4%) cholangioma, 1 cases (1/36,2.8%) biliary fistula in the experimental group, the two groups have no statistically significant difference. Conclusion: 1, TACE treatment will damage liver function, PMCT treatment 2, TACE treatment has certain damage to the cell immunity of the patients with liver cancer, and PMCT can improve the cell immunity of patients to some extent; 3, TACE and PMCT are complementary to the liver cancer. The two combination is safe, practical, effective and complementary, which can improve the curative effect of liver cancer patients and reduce the metastasis and relapse. Hair has certain clinical value.

【學位授予單位】：西南醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7

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