| Objective:Primary hepatocellular carcinoma is one of the malignant tumors with high malignancy and poor prognosis.Surgery is still the primary treatment choice for HCC.However,most patients have been developed to unresectable locally advanced stage when they receive the first treatment,thus lost the opportunity of operation.For the HCC patients who cannot receive surgical resection,minimally invasive interventional therapy has become one of the important treatment modalities.It not only improves the advanced liver cancer patients' quality of life and overall survival,but also has the equal effectiveness compared with the early surgical resection.At present,interventional treatment can be divided into the vascular interventional treatment and the non vascular interventional treatment.Vascular interventional treatment is mainly transcatheter arterial chemo embolization.Non vascular interventional therapy includes radiofrequency ablation,microwave ablation tumors,anhydrous alcohol injection,high intensity focused ultrasound and argon-helium knife,et al.Argon helium knife technology mainly focus on the treatment of local tumor target cell inactivation and is a new technology in recent years.It provides a new treatment method for the patients who can't receive or tolerate surgery resection because of its safety,effectiveness,less injury,less pain and quicker recovery.Argon helium knife technology can be used alone and combined with other treatment method,and it is safe and effective for the treatment of HCC.Therefore,we analyzed the middle-late stage of liver cancer patients with hepatic artery embolism chemotherapy treatment,argon-helium cryoablation therapy and sequential treatment of argon-helium knife cryoablationafter hepatic artery embolization chemotherapy,and hope to provide a clinical basis for the selection of appropriate treatment methods for patients with advanced hepatocellular carcinoma.Methods: We grouped a total of 156 cases in the middle-late stage of primary liver cancer between 2012-05 and 2015-06.All cases were diagnosed with HCC by ultrasound,CT,MRI and other imaging examination,and confirmed by biopsy and pathology result,according to the diagnostic criteria of primary liver cancer.And the tumor size?3cm,?15cm;primary liver carcinoma?3;metastatic lesions?5;Life in scoring method(ECOG)?2;liver function grading A ~ B Child;heart,lung and kidney function was normal;no obvious blood coagulation dysfunction;no serious infection;and the expected lifetime was more than 3 months.We devided the patients intoTACE combined with argon helium knife technology(47 cases);hepatic artery embolism chemotherapy(conventional)group(51 cases);argon helium cryoablation group(49 cases).All cases were treated for 3-6 months,and the effect was evaluated after 6-months treatment.The two treatment methods can be used repeatedly or alternately according to the patientscondition.All cases were reexamined by liver CT enhancement scan,and the efficacy was determined by mRECIST standard.The changes of serum AFP levels were observed by the electrochemical luminescence method.T cell subsets were measured by flow cytometry to observe the changes of immune function in the body.SPSS15.0 statistical software was used for statistical analysis.The rate of significant difference was analized by chi-square test.It was considered as statistically significant when P<0.05.The Log-Rank method was used for survival analysis.The comparison of mean was analized by single factor analysis of variance.Results:1 Total effective rate of combined treatment group(72.3%)was higher than argon helium knife cryoablation group(53.1%)and conventional group(47.1%),the difference was statistically significant.Effective rate of Helium knife cryoablation group was higher than that of conventional TACE group,but the difference was not statistically significant(P>0.05).2 A fetoprotein(AFP)level.The AFP level had an obvious increase with 104 cases in 147 patients,among which 104 cases with AFP > 400 ng/mL,28 cases with AFP>1000 ng/mL,40 cases with higher than normal level but lower than 400 ng/mL.The AFP levels of three groups were significantly decreased after treatment,the difference has statistical significance(P<0.05).A total of 51 cases with abnormal AFP in TACE group,> 50% drop in 35 cases(70.0%);47 cases with abnormal AFP in argon-helium knife group,> 50% drop in 38 cases(78.7%);49 cases with abnormal AFP in TACE combined with argon-helium knife cryoablation group,>50% drop in 41 cases(83.7%).3 TACE combined with Argon-helium knife cryoablation affect T cell subsets in patients with primary liver cancer.The level of CD3+?CD4 + significantly increased in three groups after treatment,and combined treatment group was of the most significant.Statistical significance was found(P<0.05).The level of CD8+?CD16+ / CD56+ for three groups has no statistical significance(P>0.05)after treatment.4 The six months survival rate had no obvious difference for the three groups(P>0.05).The one year survival rate of TACE combined with argon helium knife group was significantly higher than that of TACE group and argon helium knife group(P<0.05).The survival rate of the argon helium knife group was higher than that of the simple TACE group,but the difference was not statistically significant(P>0.05)in both the 6 month survival rate and the 1 year survival rate.5 Adverse reaction.All the 147 cases successfully finished the treatment with argon helium knife and TACE,and there were no death cases.Common adverse reactions include fever,liver pain and discomfort,mild elevation of transaminase and bilirubin,occasionally pleural effusion.Conclusions:The research showed that the argon helium cryoablation ablation combined with transcatheter arterial chemoembolization in the treatment of primary hepatocellular carcinoma(HCC)has higher effective rate than any single scheme.At the same time,it can significantly reduce the levels of alpha fetoprotein,enhance the immune function of the body and improve the 1-year survival rate,and the adverse reaction is slight. |
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