标题：高强度聚焦超声联合 125I粒子植入治疗中晚期原发性肝癌临床观察

      作者：张大为 1，何津 1，吴会静 2，张海光 1，张青芸 1，马一夫 3，马龙滨 1，陈宝明 2    （1.唐山市人民医院肝胆外科，河北 唐山 063000；2.唐山市人民医院核医学科，河北 唐山 063000；3.苏州大学医学部，江苏 苏州 215006）

      卷次： 2017年28卷1期

      【摘要】 目的 观察高强度聚焦超声(HIFU)联合 125I粒子植入治疗中晚期原发性肝癌的临床效果。方法 收集2011年2月至2014年1月唐山市人民医院收治的60例中晚期原发性肝癌患者，回顾性分析其临床资料，按照治疗方式将其分为HIFU组(n=28)与联合组（HIFU+125I粒子植入术，n=32)，比较两组患者的治疗效果、治疗前和治疗6个月时的甲胎蛋白(AFP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)水平，以及并发症发生情况；两组患者均完成2年随访，记录其复发、转移情况，统计其生存率。结果 ①联合组患者总缓解率为84.38%，高于HIFU组的60.71%，差异有统计学意义(P<0.05)；②治疗前，两组患者肝功能指标及AFP比较差异无统计学意义(P>0.05)，治疗后，两组患者AFP均降低，联合组降低幅度高于HIFU组[(86.41±35.28) ng/mL vs (116.67±38.46) ng/mL]，差异有统计学意义(P<0.05)；③联合组患者消化道出血发生率为3.13%，低于HIFU组的14.29%，但差异无统计学意义(P>0.05)，其余各并发症发生率比较差异均无统计学意义(P>0.05)；④联合组患者复发、转移率分别为 9.38%和6.25%，均低于HIFU组的 32.71%和 21.43%，仅复发率对比差异有统计学意义(P<0.05)，其 1年、2年生存率分别为65.63%、50.00%，均高于HIFU组的42.86%、25.00%，仅2年生存率比较差异有统计学意义(P<0.05)。结论 采用高强度聚焦超声联合 125I粒子植入术治疗中晚期原发性肝癌患者，总缓解率高，对患者正常肝组织损伤小，可充分杀灭肿瘤细胞，降低术后局部复发、转移率，提高术后生存率。
      【关键词】 原发性肝癌；高强度聚焦超声；125I粒子；放射疗法；疗效
      【中图分类号】 R735.7 【文献标识码】 A 【文章编号】 1003—6350（2017）01—0037—04

Clinical effect of high-intensity focused ultrasound combined with 125I seed implantation in the treatment ofadvanced primary liver cancer.
ZHANG Da-wei 1, HE Jin 1, WU Hui-jing 2, ZHANG Hai-guang 1, ZHANG Qing-yun 1,MA Yi-fu 3, MA Long-bin 1, CHEN Bao-ming 2. 1. Department of Hepatobiliary Surgery, the People's Hospital of TangshanCity, Tangshan 063000, Hebei, CHINA; 2. Nuclear Medicine Department, the People's Hospital of Tangshan City, Tangshan063000, Hebei, CHINA; 3. Department of Medicine, Suzhou University, Suzhou 215006, Jiangsu, CHINA
【Abstract】 Objective To observe the clinical effect of high-intensity focused ultrasound (HIFU) combinedwith 125I seed implantation in the treatment of advanced primary liver cancer. Methods The clinical data of 60 patientswith advanced primary liver cancer treated in the People's Hospital of Tangshan City between February 2011 and Janu-ary 2014 were retrospectively studied. According to the treatment methods, the patients were divided into HIFU group(n=28) and combined group (HIFU+125I seed implantation, n=32). The treatment effect was compared between the twogroups. The changes of alpha fetal protein (AFP), alanine aminotransferase (ALT), aspartate aminotransferase (AST) andtotal bilirubin (TBIL) liver function indexes before treatment and after 6 months of treatment were recorded. The occur-rence of complications in the two groups was observed. Both of the two groups were followed up for 2 years. The recur-rence and metastasis were recorded, and the survival rate was statistically analyzed. Results ① The total remission ratein the combined group (84.38%) was significanly higher than that in HIFU group (60.71%), P<0.05. ② Before treat-ment, there were no significant differences in liver function indexes and AFP between the two groups (P>0.05). Aftertreatment, AFP in the two groups were decreased, and the decreasing range in the combined group was greater than thatin HIFU group, (86.41±35.28) ng/mL vs (116.67±38.46) ng/mL, P<0.05.③ The incidence of gastrointestinal bleeding inthe combined group (3.13%) was lower than that in HIFU group (14.29%), with no statistically significant difference (P>0.05), and there were no significant differences in the incidence rates of other complications (P>0.05).④ The recurrenceand metastasis rates in the combined group (9.38%, 6.25%) were lower than those in HIFU group (32.71%, 21.43%), butonly the difference in recurrence rate was significant (P<0.05). The 1-year and 2-year survival rates (65.63%, 50.00%)were higher than those in HIFU group (42.86%, 25.00%), but only the difference in 2-year survival rate was statisticallysignificant (P<0.05). Conclusion HIFU combined with 125I seed implantation in the treatment of advanced primary liv-er cancer results in high total remission rate, little damage to the normal liver tissues, and can completely kill tumorcells, reduce postoperative local recurrence and metastasis rates, as well as improve postoperative survival rate.
      【Key words】 Primary liver cancer; High-intensity focused ultrasound; 125I;