|
|
高强度聚焦超声治疗结直肠癌肝转移的疗效及安全性研究
|
Abstract:
目的：探讨高强度聚焦超声即海扶刀(High-Intensity Focused Ultrasound, HIFU)在治疗结直肠癌肝转移中的疗效及安全性，并与腹腔镜肝部分切除术和消融术进行比较。方法：回顾性分析结直肠癌肝转移患者，根据治疗方式分为A组海扶刀组(34例)、B组腹腔镜组(25例)和C组消融组(25例)。观察并分析三组患者的术后疾病控制率、肿瘤标志物水平(术前及术后CA19-9、CEA)、肝功能指标(术前及术后的ALT、AST)、术后并发症(发热及疼痛)以及住院天数。结果：三组在疾病控制率和肿瘤标志物水平变化上无显著差异(P > 0.05)。A组的术后AST水平显著低于B组和C组(P < 0.05)；A组的术后发热及疼痛发生率均显著低于B组和C组(P < 0.05)；A组的住院天数显著低于B组和C组(P < 0.05)。结论：海扶刀治疗结直肠癌肝转移具有良好的安全性和患者耐受性，特别在降低术后肝功能损伤、发热、疼痛以及住院天数方面表现出明显优势，是传统手术和消融治疗的重要补充。
Objective: To investigate the efficacy and safety of high-intensity focused ultrasound (HIFU) in the treatment of colorectal cancer liver metastases and to compare it with laparoscopic liver resection and ablation therapy. Methods: A retrospective analysis of patients with colorectal cancer liver metastases was conducted, categorizing them into three groups based on treatment modalities: Group A (HIFU group, 34 cases), Group B (Laparoscopic group, 25 cases), and Group C (Ablation group, 25 cases). Postoperative disease control rate, tumor marker levels (preoperative and postoperative CA19-9, CEA), liver function indices (preoperative and postoperative ALT, AST), postoperative complications (fever and pain), and hospital stay duration were observed and analyzed among the three groups. Results: There were no significant differences in disease control rate and changes in tumor marker levels among the three groups (P > 0.05). Group A exhibited significantly lower postoperative AST levels compared to Groups B and C (P < 0.05); the incidence of postoperative fever and pain in Group A was significantly lower than in Groups B and C (P < 0.05); and the length of hospital stay in Group A was significantly shorter than in Groups B and C (P < 0.05). Conclusion: HIFU treatment for colorectal cancer liver metastases demonstrates good safety and patient tolerability, particularly showing significant advantages in reducing postoperative liver function damage, fever, pain, and hospital stay duration, making it an important adjunct to traditional surgery and ablation therapy.
| [1] | Adam, R., De Gramont, A., Figueras, J., Guthrie, A., Kokudo, N., Kunstlinger, F., et al. (2012) The Oncosurgery Approach to Managing Liver Metastases from Colorectal Cancer: A Multidisciplinary International Consensus. The Oncologist, 17, 1225-1239. https://doi.org/10.1634/theoncologist.2012-0121 |
| [2] | Engstrand, J., Nilsson, H., Strömberg, C., Jonas, E. and Freedman, J. (2018) Colorectal Cancer Liver Metastases—A Population-Based Study on Incidence, Management and Survival. BMC Cancer, 18, Article No. 78. https://doi.org/10.1186/s12885-017-3925-x |
| [3] | Reissfelder, C., Rahbari, N.N., Koch, M., Ulrich, A., Pfeilschifter, I., Waltert, A., et al. (2009) Validation of Prognostic Scoring Systems for Patients Undergoing Resection of Colorectal Cancer Liver Metastases. Annals of Surgical Oncology, 16, 3279-3288. https://doi.org/10.1245/s10434-009-0654-7 |
| [4] | Stewart, C.L., Warner, S., Ito, K., Raoof, M., Wu, G.X., Kessler, J., et al. (2018) Cytoreduction for Colorectal Metastases: Liver, Lung, Peritoneum, Lymph Nodes, Bone, Brain. When Does It Palliate, Prolong Survival, and Potentially Cure? Current Problems in Surgery, 55, 330-379. https://doi.org/10.1067/j.cpsurg.2018.08.004 |
| [5] | Norén, A., Sandström, P., Gunnarsdottir, K., Ardnor, B., Isaksson, B., Lindell, G., et al. (2018) Identification of Inequalities in the Selection of Liver Surgery for Colorectal Liver Metastases in Sweden. Scandinavian Journal of Surgery, 107, 294-301. https://doi.org/10.1177/1457496918766706 |
| [6] | Margonis, G.A., Sergentanis, T.N., Ntanasis-Stathopoulos, I., Andreatos, N., Tzanninis, I., Sasaki, K., et al. (2018) Impact of Surgical Margin Width on Recurrence and Overall Survival Following R0 Hepatic Resection of Colorectal Metastases: A Systematic Review and Meta-Analysis. Annals of Surgery, 267, 1047-1055. https://doi.org/10.1097/sla.0000000000002552 |
| [7] | Tejero-Pintor, F.J., Sarmentero-Prieto, J.C., Bailón-Cuadrado, M., Blanco-Álvarez, J.I., Sánchez-González, J., Velasco-López, R., et al. (2019) Doble metástasis hepática de doble neoplasia de colon: Adenocarcinoma y tumor neuroendocrino. Gastroenterología y Hepatología, 42, 624-625. https://doi.org/10.1016/j.gastrohep.2019.05.004 |
| [8] | Wakabayashi, G., et al. (2015) Recommendations for Laparoscopic Liver Resection: A Report from the Second International Consensus Conference Held in Morioka. Annals of Surgery, 261, 619-629. |
| [9] | Buell, J.F., et al. (2008) The Current Role of Laparoscopic Liver Resection for the Treatment of Liver Tumors. Journal of the American College of Surgeons, 206, 322-331. |
| [10] | Gillams, A. (2013) The Use of Radiofrequency in the Treatment of Liver Metastases. Cancer Imaging, 13, 102-111. |
| [11] | Shady, W., Petre, E.N., Gonen, M., Erinjeri, J.P., Brown, K.T., Covey, A.M., et al. (2016) Percutaneous Radiofrequency Ablation of Colorectal Cancer Liver Metastases: Factors Affecting Outcomes—A 10-Year Experience at a Single Center. Radiology, 278, 601-611. https://doi.org/10.1148/radiol.2015142489 |
| [12] | Marinova, M., Khouri, D., Küppers, J., Ramig, O., Strunk, H.M., Breuers, J., et al. (2024) Study Protocol of a Randomized, Two-Arm, Phase I/II Trial Investigating the Feasibility, Safety, and Efficacy of Local Treatment with Us-Guided High-Intensity Focused Ultrasound in Combination with Palliative Chemotherapy in Inoperable Pancreatic Cancer. Journal of Clinical Medicine, 13, Article No. 3717. https://doi.org/10.3390/jcm13133717 |
| [13] | 刘娟, 蒲晏均, 伍映鑫, 等. 结直肠癌肝转移以手术治疗为主的综合治疗效果分析[J]. 中国处方药, 2018, 16(1): 4-5. |
| [14] | Izzo, F., Granata, V., Grassi, R., Fusco, R., Palaia, R., Delrio, P., et al. (2019) Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update. The Oncologist, 24, e990-e1005. https://doi.org/10.1634/theoncologist.2018-0337 |
| [15] | 王鹏, 任卫东. 射频消融治疗肝细胞癌的机制[J]. 临床肝胆病杂志, 2017, 33(2): 359-363. |
| [16] | Al-Bataineh, O., Jenne, J. and Huber, P. (2012) Clinical and Future Applications of High Intensity Focused Ultrasound in Cancer. Cancer Treatment Reviews, 38, 346-353. https://doi.org/10.1016/j.ctrv.2011.08.004 |
| [17] | Takahashi, H. and Berber, E. (2020) Role of Thermal Ablation in the Management of Colorectal Liver Metastasis. Hepatobiliary Surgery and Nutrition, 9, 49-58. https://doi.org/10.21037/hbsn.2019.06.08 |
| [18] | Hompes, D., Prevoo, W. and Ruers, T. (2011) Radiofrequency Ablation as a Treatment Tool for Liver Metastases of Colorectal Origin. Cancer Imaging, 11, 23-30. |
| [19] | Seo, J., Koizumi, N., Mitsuishi, M. and Sugita, N. (2017) Ultrasound Image Based Visual Servoing for Moving Target Ablation by High Intensity Focused Ultrasound. The International Journal of Medical Robotics, 13, e1793. |
| [20] | De Maio, A., Alfieri, G., Mattone, M., Ghanouni, P. and Napoli, A. (2024) High-Intensity Focused Ultrasound Surgery for Tumor Ablation: A Review of Current Applications. Radiology: Imaging Cancer, 6, e230074. https://doi.org/10.1148/rycan.230074 |
| [21] | Yang, X., Liao, Y., Fan, L., Lin, B., Li, J., Wu, D., et al. (2024) High-Intensity Focused Ultrasound Ablation Combined with Immunotherapy for Treating Liver Metastases: A Prospective Non-Randomized Trial. PLOS ONE, 19, e0306595. https://doi.org/10.1371/journal.pone.0306595 |
