摘要
目的探讨经皮射频消融(RFA)对邻近膈肌、肠管、胆囊和肝表面等难治部位肝癌的个体化治疗方案。方法采用超声引导经皮RFA治疗228例位于肝脏外周区域的非手术适应证肝癌患者,共274个病灶,其中,59个病灶邻近肠管,115个病灶邻近膈肌,54个病灶邻近胆囊,46个病灶邻近肝表面。肿瘤最大径平均(3.7±1.2)cm(1.2～7.0cm)。对不同部位肿瘤建立相应的个体化方案指导治疗,1个月后行增强CT判断肿瘤早期灭活率并定期随访。结果肿瘤早期总灭活率为91.6%;邻近肠管、膈肌、胆囊和肝表面的肿瘤早期灭活率分别为91.5%、90.4%、92.6%和93.5%,局部复发率分别为8.5%、9.6%、7.4%和6.5%。本组患者1、2、3年的生存率分别为82.3%、62.9%、53.7%。228例共计治疗358人次,较严重并发症占3.4%,包括出血2人,邻近脏器(膈肌、肠管)损伤6人,针道种植4人,共计12人次。结论对RFA易灼伤邻近肝外结构的难治性肝癌,本研究采用个体化方案策略指导治疗,获得较好的肿瘤灭活率并降低并发症,本方案拓展了肝癌RFA治疗适用范围,有助于提高RFA在肝癌综合治疗中的作用。
Objective To evaluate the effectiveness of a tailored approach to radiofrequency ablation （RFA） of hepatocellular carcinoma （HCC）. Methods Uhrasound-guided percutaneous RFA was performed in 274 tumors of 228 patients located at liver periphery, including 59 near the bowel, 115 near the diaphragm, 54 near the gallbladder, and 46 near the liver surface. The tumor sizes ranged 1.2-7.0 cm [ mean （ 3.7 ±1.2） cm]. A tailored treatment strategy was established for tumors in different locations. Contrast-enhanced CT was performed one month later to evaluate the early necrosis rate of the treated tumors. Results Early tumor necrosis rate was 91.6% of the peripherally located HCC, including 91.5% of the tumors near the bow- el, 90.4% near the diaphragm, 92.6% near the gallbladder, and 93.5% near the liver surface. Local tumor recurrence rates were 8.5% , 9.6% , 7.4% , and 6.5% for tumors near the bowel, diaphragm, gallbladder, and liver surface, respectively. The 1 -, 2-, and 3-year survival rate of this group were 82.3 %, 62.9 %, and 53.7% , respectively. Major complications occurred in 3.3% of the treatment sessions, including haemorrhage （ n = 2 ） , nearby structure injury （ n = 6 ）, and needle tract seeding proach to RFA provides a promising treatment option for refractory tumor necrosis rate and low complication rate. （ n = 4）. Conclusion The tailored approach to RFA provides a promising treatment option for refractory peripherally located HCC with satisfactory tumor necrosis rate and low complication rate.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2008年第1期15-21,共7页
Acta Academiae Medicinae Sinicae
基金
北京市重大项目培育专项基金(Z0005190040431)
国家高技术研究发展计划项目(863项目)(2007AA02Z4B8)~~
关键词
射频消融
肝癌
生存期
并发症
超声
radiofrequency ablation
hepatocellular carcinoma
survival rate
complications
ultrasound
