摘要
目的:通过对难治肝细胞癌(hepatocellular carcinoma,HCC)射频消融(radiofrequency ablation,RFA)治疗中实施个体化治疗方案及策略,讨论此类肝癌行规范化治疗的远期疗效。方法:在超声及超声造影(contrast-enhanced ultrasound,CEUS)引导下,对大体积肿瘤、富血供肿瘤及邻近周围解剖结构肿瘤采用相应的个体化治疗方案及策略规范化RFA,共治疗HCC468例,其中有22例因肿瘤巨大、弥漫多发或明显侵犯周围脏器而行姑息性RFA,余446例HCC为本文研究对象,其中男性367例,女性79例。共680人次(828个病灶)行经皮RFA治疗,平均大小(3.6±1.4)cm,规律性随访时间3～119个月。结果:1个月总体灭活率为97%(803/828灶),复发率为7.2%(60/828灶),总体1年、3年、5年生存率分别为85.3%、61.3%、47.0%。其中>3.5cm肿瘤灭活率为90.8%(275/303灶),3.1～5.0cm和>5.0cm肿瘤5年生存率分别为45.1%、35.9%。邻近胆囊、膈肌、肠管及大血管肿瘤占总体病灶40.3%(334/828灶),邻近胆囊肿瘤灭活率为93.5%(58/62灶),邻近膈肌为92.5%(123/133灶),邻近肠管为92.4%(61/66灶),邻近大血管为93.2%(68/73灶)。本组严重并发症发生率3.1%(21/680人次),包括腹腔内出血5例、胆管损伤4例、血性胸水2例、肠穿孔3例、针道种植转移7例,仅1例发生肠穿孔相关死亡。结论:规范化RFA治疗方案及个体化治疗策略有助于提高大肿瘤、特殊部位肿瘤的灭活率并降低并发症,从而提高射频疗效及安全性,并拓展RFA对中国肝癌治疗的适应证范围,具重要临床应用价值。
Objective：To investigate the efficacy of radiofrequency ablation （RFA） for hepatocellular carcinoma （HCC） according to standardized treatment strategy and individualized protocol. Methods： A total of 468 patients of HCC underwent ultrasound/Contrast-enhanced ultrasound guided RF ablation in our department according to individualized protocol for large tumors,hypervascular tumors and tumors located adjacent to important structures in our study,of which 22 HCCs having undergone palliative RF ablation were excluded because of huge size,diffusive multiple tumors or adjacent structures invasion. The remaining 446 HCCs （680 sessions） were included and followed-up regularly to assess treatment efficiency. Of the 446 patients,367 were male and 79 were female. 828 lesions underwent RFA. The mean size of tumors was （3.6±1.4）cm. Regular follow-up was conducted for 3-119 months. In this study,long-term outcome of various refractory tumors were also investigated.Results： The overall ablation success rate was 97%（803/828） 1 month after RFA. The recurrent rate was 7.2%（60/828）. Base on Kaplan-Meier method,the 1-,3- and 5-year overall survival rates after RF ablation were 85.3%,61.3% and 47.0%,respectively. The ablation success rate of tumors larger than 3.5cm was 90.8%（275/303）. The 5-year survival rates of patients who had HCC for 3.15 cm and 〉5 cm were 45.1% and 35.9%,respectively. In this study,there were 40.3%（334/828） tumors located adjacent to important structures. The ablation success rates of these tumors located adjacent to gallbladder,diaphragm,bowel and major vessels were 93.5%（58/62）,92.5%（123/133）,92.4%（61/66） and 93.2%（68/73）,respectively. The incidence of major complications was 3.1%（21/680）,which included 5 intraperitoneal hemorrhages,4 biliary injuries,2 hemopleural effusions,3 bowel perforations and 7 needle tract seedings. Treatment-related death occurred in 1 case of bowel perforation. Conclusion： In RF ablation of refractory HCC,application of standardized treatment strategy and individualized protocol plays important roles in improving ablation success rate and minimizing potential complications. It could extend the indications of RF ablation for HCC in China.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2010年第6期716-721,共6页
Journal of Peking University:Health Sciences
基金
国家高技术研究发展计划专项经费(2007AA02Z4B8)资助~~
关键词
导管消融术
癌
肝细胞
超声检查
存活率
Catheter ablation； Carcinoma,hepatocellular； Ultrasonography； Survival rate；
