CT引导下经皮穿刺氩氦冷冻治疗对老年原发性巨块型肝癌患者生活质量的影响

摘要

Objective To observe the changes of quality of life (QOL) of huge hepatocellular carcinoma (HCC) patients over 60 years treated with CT guided percutaneous Argon-Helium cryoablation(PAHC).Methods There were 91 HCC patients over 60 years who had received CT guided PAHC.The diameter of tumors in all the patients was larger than 10 cm.The qualities of life of the patients were evaluated before cryoablation, and 1 w, 1,3 months after cryoablation by Functional Assessment of Cancer Therapy-Hepatobiliary questionaire (FACT-Hep).The tumor loads were evaluated by tumor markers and CT scans.Results There were 88 cases filled all the FACT-Hep.At 1 w after PAHC, physical well-being( P =0.017)and functional well-being ( P ＜0.001 )were siguificantly decreased greatly, emotional wellbeing was improved slightly (P = 0.024).There was no change in additional concerns (Hep) (P=0.665 ), social/family well-being was decreased ( P ＜ 0.008).At 1 month after PAHC, physical well-being, functional well-being and additional concerns (Hep) were increased than those before treatment( P ＜0.001 ), aocial/family well-being was recovered( P ＞ 0.05 ).The total FACT-Hep was higher than that before PAHC(P＞0.05).At 3 month after PAHC, each part of FACT-Hep was improved obviously (P ＜0.001 )than that before PAHC, social/family well-being was lower than that in 1 month after PAHC, but there was no significant difference ( P ＞ 0.05 ).Conclusions It could obviously improve quality of life of old HCC patients of diameter larger than 10 cm treated with PAHC.It needs the further research on long-term QOL changes and survival.%目的 评价CT引导下经皮穿刺氩氦冷冻治疗对＞60岁原发巨块型肝癌患者生活质量(QOL)的影响.方法 本组91例,肿瘤直径10～14 cm,均为富血供.所有病例CT引导下实施肝脏病灶经皮穿刺氩氦冷冻治疗.分别于术前,术后1 w,1个月,3个月评价生活质量,复查肿瘤标志物、CT,评价肿瘤负荷变化.生活质量采用肝胆肿瘤治疗功能评定量表(FACT-Hep)评价QOL变化.结果 随访期间88例患者完成所有时间点QOL调查量表.术后1 w身体状况(P=0.017)及功能状况(P<0.001)模块有较大幅度降低,情感状况较术前轻度改善(P=0.024),肝癌特异性模块无明显变化(P=0.665),社会/家庭状况则下降,差异有显著性意义(P<0.01).术后1个月身体状况(P<0.001),功能状况(P<0.001),肝癌特异性模块得分(P<0.001)较术前明显上升,社会/家庭状况回复至术前状况(P>0.05),FACT-Hep总分开始高于术前水平(P<0.001).术后3个月,除经济状况模块外(P>0.05),所有模块及FACT-Hep总分均较术前改善(P<0.001).其中功能状态和情感状态最为明显.社会家庭状况较术后1个月时略有所下降,但差异无显著性意义(P>0.05).结论 经皮穿刺氩氦冷冻治疗巨块型肝癌,在短期内可提高老年患者生活质量.对巨块型HCC,经皮穿刺氩氦冷冻治疗对长期QOL及生存期的影响有待于进一步研究.