摘要
目的探讨经皮阻断荷瘤血供方法对射频消融治疗富血供肝癌的可行性及应用效果。方法101例非手术适应证拟行射频消融(RFA)的血供丰富肝癌患者中71例74灶行经皮射频消融阻断荷瘤动脉(PAA)后按常规方法消融肿瘤其他区域(PAA+RFA组),对照组83例102灶按常规行单纯射频消融(RFA组);另30例经动脉导管化栓塞疗效不佳者行超声引导经皮穿刺荷瘤动脉栓塞(PAE)后行常规治疗(PAE+RFA组),23例单纯RFA为对照组;所有患者均即刻行彩超及超声造影检查观察肿瘤血供阻断状况,并在治疗后1、3、6月行增强CT/核磁共振评价RFA疗效。结果PAA后87.8%(65/74)主荷瘤血供阻断;即刻RFA治疗1月后肿瘤灭活率为90.5%(67/74),对照组为90.2%(92/102);6月后复发率分别为17.6%(13/74)和31.4%(32/102)(P=0.038);两组每个肿瘤平均消融(2.76±1.12)、(3.36±1.60)个球灶(P=0.01)。PAE后88.6%(31/35支)主荷瘤血管阻断成功;PAE+RFA组RFA后1月、1年肿瘤灭活率为92.6%(25/27)、85.2%(23/27),均显著高于对照组65.2%(15/23)(P=0.030)、56.5%(13/23)(P=0.024)。结论经皮PAA和PAE阻断肿瘤血供联合RFA,可提高肿瘤的灭活率,有效降低肿瘤复发;其中PAA容易操作,为RFA治疗血供丰富大肝癌提供简便易行的附加治疗策略。
Objective To explore the feasibility and outcome of radiofrequency ablation（RFA） in blocking feeding vessels of hypervascular hepatocellular carcinoma（HCC）.Methods Totally 101 patients pathologically confirmed hypervascular HCC were included in the study.In percutaneous arterial ablation（PAA）＋RFA group,71 patients with 74 HCC underwent PAA before classical RFA of the other regions of the tumors,while in the RFA group,another 83 patients with 102 HCC were treated with RFA directly.For another 30 patients who responded poorly to transcatheter arterial chemoembolization were treated with percutaneousarterial embolization（PAE）,followed by RFA;another 23 patients were treated with RFA alone were regarded as the control group.Contrast-enhanced CT and magnetic resonance imaging were used as post-RFA imaging follow-up at 1,3,and 6 month.Results In PAA＋RFA group,post-PAA imaging showed blocked blood flow in 65（87.8%） HCC.There were average 2.76±1.12 ablated foci per HCC in PAA＋RFA group and 3.36±1.60 ablated foci per HCC in control group（P=0.01）.The tumor necrosis rate at 1 month after RFA was 90.5%（67/74） in PAA＋RFA group and 90.2%（92/102） in control group.HCC recurrence rate at 6 month after RFA was 17.6%（13/74） in PAA＋RFA group and 31.4%（32/102） in control group（P=0.038）.In PAE＋RFA group,88.6% of the main feeding vessels were blocked.The tumor necrosis rate at 1 and 6 month after FRA was 92.6%（25/27） and 85.2%（23/27）in PAA＋RFA group and 65.2%（15/23）（P=0.030） and 56.5%（13/23）（P=0.024） in control group.Conclusion PAA and PAE can block the feeding vessels of HCC,enhance the ablated necrosis in the tumor,decrease post-RFA recurrence,and therefore provides a safe and feasible method for treating hypervascular HCC.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2008年第4期448-454,共7页
Acta Academiae Medicinae Sinicae
基金
北京市重大项目培育专项基金(Z0005190040432)
国家高技术研究发展计划项目(863计划)(2007AA02Z4B8)~~
关键词
肝癌
荷瘤血管
射频消融
血管栓塞
hepatocellular carcinoma
feeding vessel
radiofrequency ablation
blood embolism
