摘要
目的 探讨冷循环射频消融治疗肝癌的方法、适应症及其疗效。方法 应用冷循环射频消融治疗肝细胞癌患者 168例共 217个病灶,其中第 1组 113例共 147个病灶,肿瘤直径 <3cm;第 2组 35例共 49个病灶,肿瘤直径 3~5cm;第 3组 20例共 21个病灶,肿瘤直径>5cm。观察治疗前后患者丙氨酸转氨酶、甲胎蛋白(AFP)、CD4+、CD8+、CD4+ /CD8+值和可溶性白介素 2受体 (sIL 2R)、二维及彩色多普勒血流显像、超声造影、增强CT/MRI的改变。记录患者治疗后 1、2、3年生存率。结果 第 1组病灶完全坏死率为 89. 1% (131 /147),术后 1个月AFP明显下降,术后 1、2、3年生存率分别为 96. 6% (84 /87)、71. 2% (42 /59)和 63. 0% (17 /27)。第2组病灶完全坏死率为 53. 1% ( 26 /49 ),术后 1月AFP下降,术后 1、2、3年生存率分别为 82. 1% ( 23 /28 )、63. 2% (12 /19)和 44. 4% (4 /9)。第 3组仅 4个病灶 (占 19. 0% )为完全坏死,术后 1个月仅 1例AFP下降至25μg/L以下, 1年生存率 62. 5% (10 /16), 2年生存率 44. 4% (4 /9),存活 3年以上仅 1例(1 /4)。20例肝细胞癌患者与健康对照者相比CD4+、CD4+ /CD8+显著降低,sIL 2R显著增高;治疗后CD4+值升高、CD4+ /CD8+值升高,sIL 2R显著降低。结论 射频消融治疗小肝癌可获显著疗效。
Objective To evaluate the therapeutic effects of the cooled-tip radiofrequency ablation(CRFA) in the treatment of hepatocellular carcinoma(HCC).Methods One hundred and sixty-eight patients of HCC with 217 lesions were treated by CRFA.Among them one hundred and thirteen patients with 147 nodules(diameter <3 cm) were in the first group,thirty-five patients with 49 nodules(diameter 3-5 cm) in the second group,twenty patients with 21 nodules(diameter >5 cm) in the third group.ATL,serum AFP,CD4^+,CD8^+,CD4^+/CD8^+,sIL-2R,B-mode ultrasonography,color Doppler flow imaging(CDFI), contrast ultrasound,contrast enhanced CT/MRI were examined before and after CRFA.Survival rate of 1-year,2-year,3-year was recorded.Results (89.1%) of lesions were completely necrotic in the first group.Serum AFP value was significantly decreased 1 month after CRFA.Survival rate of 1-year,2-year,3-year was (96.6%),(71.2%),(63.0%),respectively.(53.1%) of lesions were completely necrotic in the second group.Serum AFP value was decreased 1 month after CRFA.Survival rate of 1-year,2-year,3-year was (82.1%),(63.2%),(44.4%),respectively.In the third group,only 4 lesions were completely necrotic.AFP value was less than 25 μg/L 1 month after CRFA only in one patient.Survival rate of 1-year,2-year,3-year was (62.5%)(10/16),(44.4%)(4/9),(25.0%)(1/4),respectively.Compared with normal controls,CD4^+ and CD4^+/CD8^+ value of 20 patients with HCC were significantly decreased and sIL-2R value significantly increased before CRFA, and CD4^+ and CD4^+/CD8^+ value of 20 patients with HCC were significantly increased and sIL-2R value significantly decreased after CRFA.Conclusions CRFA can improve anti-tumor immune of the patients.Definite therapeutic response of RFA is obvious in the treatment of small HCCs.The therapy including CRFA,TACE and percutaneous ethanol injection should be used in large HCCs.
出处
《中华超声影像学杂志》
CSCD
2005年第3期208-211,共4页
Chinese Journal of Ultrasonography
基金
广东省自然科学基金(31710)
广东省卫生厅医学科研项目(A2003203)资助
