汪平　鲍鹰

[摘要] 目的 探讨疏肝理气汤联合射频消融（RFA）对晚期肝癌预后的影响。 方法 回顾性分析2011年2月～2014年4月我院80例接受RFA治疗的晚期肝癌患者。其中40例患者在接受RFA治疗同时，服用疏肝理气汤（中药组），其余40例患者仅接受RFA治疗（对照组）。比较两组并发症和长期生存率等指标。 结果两组患者的一般资料无显著差异。未发现明显中药毒性反应。中药组肝功能衰竭发生率明显低于对照组（4/40 vs 12/40，P=0.0253）。中药组有更多患者完成RFA治疗（36/40 vs 27/40，P=0.0139）。中药组3年总生存率显著高于对照组（42.50% vs 32.50%；HR：1.8122；95%CI：1.0274～3.1964；P=0.0299）。 结论 疏肝理气汤能有效减少RFA引起的肝功能衰竭，提高治疗成功率，从而改善晚期肝细胞癌患者的长期生存。

[关键词] 肝细胞癌；射频消融；总生存率；并发症

[中图分类号] R259；R735.7 [文献标识码] B [文章编号] 1673-9701（2017）23-0112-04

[Abstract] Objective To investigate the effect of Shugan Liqi decoction combined with radiofrequency ablation（RFA） on the prognosis of advanced liver cancer. Methods 80 patients with advanced liver cancer who were treated with RFA from February 2011 to April 2014 were retrospectively analyzed. 40 patients were given Shugan Liqi decoction（Chinese medicine group） while receiving RFA treatment. The remaining 40 patients were only given RFA（control group）. Complications， long-term survival and other indicators were compared between the two groups. Results There was no significant difference in the general data between the two groups. No obvious Chinese medicine toxicity was found. The incidence rate of liver failure in Chinese medicine group was significantly lower than that in the control group（4/40 vs 12/40， P=0.0253）. There were more patients in the Chinese medicine group who completed RFA treatment（36/40 vs 27/40， P=0.0139）. The overall 3-year survival rate in Chinese medicine group was significantly higher than that in the control group（42.50% vs 32.50%； HR： 1.8122； 95%CI： 1.0274-3.1964； P=0.0299）. Conclusion Shugan Liqi decoction can effectively reduce the liver failure caused by RFA and improve the success rate of treatment， so as to improve the long-term survival of patients with advanced hepatocellular carcinoma.

[Key words] Hepatocellular carcinoma； Radiofrequency ablation （RFA）； Overall survival rate； Complications

肝細胞癌（hepatocellular carcinoma，HCC）是目前世界上最常见的消化道恶性肿瘤之一，每年有超过一百万新确诊病例，其中一半以上发生在中国[1]。手术切除和肝移植是肝癌治疗的根治性手段，但由于大部分患者发现时已经到了晚期，因此只有不足30%的患者有机会接受根治性治疗[2，3]。射频消融术（radiofrequency ablation，RFA）作为一种新兴的局部治疗手段，已经被广泛应用于肝癌治疗[4]。有研究显示RFA对于单发的小肝癌其疗效甚至可与手术切除媲美，而且在多发肝癌甚至是晚期肝癌，RFA仍能发挥积极治疗作用，提高患者的长期生存。然而，RFA程序通常会引起严重的并发症，包括肝衰竭、胸膜积液、出血和肝脓肿，甚至有危及生命的并发症发生。一旦发生严重并发症，RFA将不得不终止，因此RFA治疗中晚期肝癌的5年生存率仍低于10%。……