人工胸水技术联合射频消融术对膈顶部肝癌患者的临床疗效

doi:10.11958/20250709

天津医药 ›› 2025, Vol. 53 ›› Issue (8): 856-859.doi: 10.11958/20250709

人工胸水技术联合射频消融术对膈顶部肝癌患者的临床疗效

张兴隆¹(), 何红梅², 张静², 石亚楠¹, 任兰春³, 秦晓辉⁴, 孙江华⁵

1 邯郸市第一医院肿瘤二科（邮编056000）
2 邯郸市第一医院内分泌一科（邮编056000）
3 邯郸肝病医院肝病科
4 邯郸市第一医院普外科（邮编056000）
5 邯郸市第一医院综合外科（邮编056000）

收稿日期:2025-02-24 修回日期:2025-05-19 出版日期:2025-08-15 发布日期:2025-08-12
作者简介:张兴隆（1984），男，副主任医师，主要从事恶性肿瘤微创治疗方面研究。E-mail：pzgrlusy@163.com
基金资助:
邯郸市科学技术研究与发展计划项目(22422083063ZC)

The clinical efficacy of artificial pleural effusion combined with radiofrequency ablation in patients with phrenic top liver cancer

ZHANG Xinglong¹(), HE Hongmei², ZHANG Jing², SHI Ya’nan¹, REN Lanchun³, QIN Xiaohui⁴, SUN Jianghua⁵

1 Department of Oncology 2, Handan First Hospital, Handan 056000, China
2 Department of Endocrinology 1, Handan First Hospital, Handan 056000, China
3 Department of Liver Disease, Handan Liver Disease Hospital
4 Department of General Surgery, Handan First Hospital, Handan 056000, China
5 Department of Comprehensive Surgery, Handan First Hospital, Handan 056000, China

Received:2025-02-24 Revised:2025-05-19 Published:2025-08-15 Online:2025-08-12

张兴隆, 何红梅, 张静, 石亚楠, 任兰春, 秦晓辉, 孙江华. 人工胸水技术联合射频消融术对膈顶部肝癌患者的临床疗效[J]. 天津医药, 2025, 53(8): 856-859.

ZHANG Xinglong, HE Hongmei, ZHANG Jing, SHI Ya’nan, REN Lanchun, QIN Xiaohui, SUN Jianghua. The clinical efficacy of artificial pleural effusion combined with radiofrequency ablation in patients with phrenic top liver cancer[J]. Tianjin Medical Journal, 2025, 53(8): 856-859.

摘要/Abstract

摘要：

目的探究人工胸水技术联合射频消融术对膈顶部肝癌患者的临床疗效。方法前瞻性选取膈顶部肝肿瘤患者92例，通过随机数字表法分为对照组（46例，射频消融）和观察组（46例，射频消融+人工胸水）。比较治疗1个月后的临床疗效、首次手术消融时间、治疗前和治疗1个月后血清甲胎蛋白（AFP）水平、并发症。2组术后均随访2年，比较生存情况。结果 2组术后1个月时增强MRI或增强CT显示对照组肿瘤完全消融率低于观察组（76.09% vs. 93.48%，P<0.05）。观察组手术消融时间短于对照组[（9.64±1.22）min vs. （11.15±1.47）min，P<0.05]；观察组治疗后1年（82.61% vs. 58.70%）和2年（71.74% vs. 47.83%）生存率均高于对照组（P<0.05）；治疗后2组血清AFP水平均下降，且观察组低于对照组（P<0.05）；观察组并发症总发生率低于对照组（8.70% vs. 23.91%，P<0.05）。92例患者随访时间7~29个月，平均（20.17±4.61）个月，随访期间对照组局部肿瘤进展率高于观察组（36.96% vs. 10.87%，P<0.01）。结论人工胸水技术联合射频消融能够有效提高膈顶部肝癌患者的临床疗效和生存率，降低血清AFP水平，减少并发症发生。

关键词: 肝肿瘤, 胸水, 射频消融术, 甲胎蛋白类, 临床疗效

Abstract:

Objective To explore the effect of artificial pleural effusion combined with radiofrequency ablation in patients with phrenic top liver cancer. Methods A total of 92 patients with liver tumors at top of the diaphragm were prospectively selected and divided into the control group (46 cases, radiofrequency ablation) and the observation group (46 cases, radiofrequency ablation + artificial pleural effusion) by the random number table method. Clinical outcomes one month after treatment, time to first surgical ablation, serum alpha-fetoprotein (AFP) levels and complications before treatment and one month after treatment were compared. Both groups were followed up for 2 years after the operation, and survival conditions of patients were compared. Results Enhanced MRI or enhanced CT at 1 month after surgery in the 2 groups showed that the complete tumor ablation rate was lower in the control group than that in the observation group (76.09% vs. 93.48%, P<0.05). The surgical ablation time of the observation group was shorter than that of the control group [(9.64±1.22) min vs. (11.15±1.47) min, P<0.05]. The survival rates were higher in the observation group than those in the control group at 1 year (82.61% vs. 58.70%) and 2 years (71.74% vs. 47.83%) after treatment (P<0.05). Serum AFP levels decreased in both groups after treatment, and those were lower in the observation group than those in the control group (P<0.05). The total complication rate of the observation group was lower than that of the control group (8.70% vs. 23.91%, P<0.05). The follow-up period of 92 patients ranged from 7 to 29 months, with a mean of (20.17±4.61) months. The local tumor progression rate was higher in the control group than that in the observation group during the follow-up period (36.96% vs. 10.87%, P<0.05). Conclusion Artificial pleural effusion combined with radiofrequency ablation can effectively improve the clinical efficacy and survival rate of patients with liver cancer, reduce the level of serum AFP and decrease the occurrence of complications.

Key words: liver neoplasms, hydrothorax, radiofrequency ablation, alpha-fetoproteins, clinical effect

中图分类号:

R735.7，R454.1，R561.3

图/表 3

表1 2组治疗前后血清AFP水平比较

Tab.1 Comparison of serum AFP levels before and after treatment between the two groups （n=46，μg/L，$\bar{x}±s$）

组别	治疗前	治疗后	t
对照组	359.77±46.28	97.84±22.16	32.421^＊＊
观察组	368.54±41.22	79.85±14.63	43.884^＊＊
t	0.960	4.591^＊

表2 2组并发症情况比较

Tab.2 Comparison of complications between the two groups [例（%）]

组别	n	肺损伤	皮下水肿	肝区疼痛	发热	总发生
对照组	46	2（4.35）	3（6.52）	3（6.52）	3（6.52）	11（23.91）
观察组	46	1（2.17）	1（2.17）	1（2.17）	1（2.17）	4（8.70）
χ²						3.903^＊

图1 2组生存曲线比较

Fig.1 Comparison of survival curves between the two groups

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人工胸水技术联合射频消融术对膈顶部肝癌患者的临床疗效

The clinical efficacy of artificial pleural effusion combined with radiofrequency ablation in patients with phrenic top liver cancer

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