肝癌射频消融治疗后疗效及影响因素分析

目的：探讨肝细胞癌（hepatocellular carcinoma，HCC）射频消融（radio—frequency ablation，RFA）治疗后影响局部肿瘤进展的危险因素。方法：116例患者共152个病灶经RFA治疗后24h行超声造影（Contrast—enhanced Ultrasound，CEUS）检查，对发现残留及消融安全范围不足的病灶及时补充治疗，随访4～19个月，运用统计学方法分析影响局部肿瘤进展的因素。结果：152个病灶中3个病灶初次治疗后CEUS显示有残留，补充治疗后达消融安全范围充足。最终9个病灶（5．9％）显示消融安全范围不足，一个月后影像学结合肿瘤标志物等检查证实两个病灶有残留，7个病灶治疗完全；另外143个（94．1％）治疗后CEUS显示消融安全范围充足的病灶，一个月后影像学结合肿瘤标志物等检查证实治疗完全。随访4-19个月，152个病灶有10个病灶证实有局部复发。运用多因素统计分析，结果显示治疗安全范围、肿瘤生长方式是射频治疗后肿瘤局部复发的独立影响因素。结论：HCC行RFA治疗需重视术前对病灶的生长方式，术后病灶的消融安全范围等的评估，以达到彻底灭活肿瘤。提高RFA疗效的目的。

EFFECT AND PROGNOSTIC ANALYSIS OF RADIOFREQUENCY ABLATIONON THE TREATMENT OF HEPATOCELLULAR CARCINOMA

Objective： Discussing the prognostic factors affecting local tumor progression after radiofrequency ablation （RFA） of hepatocellular carcinoma （HCC） so as to improve effect evaluation scheme and treat- ment effect. Methods： A total of 152 lesions were studied in 116 patients. Each patient underwent contrastenhanced ultrasound （CEUS） 24 h after RFA. A supplementary therapy was carried out when there was residual or insufficient safety margin. The prognostic factors affecting local tumor progression after 4-19 months＇ follow up were analyzed. Results： Three of the 152 lesions were proved tumor residual by CEUS after the primary treatment. At the end, 9 lesions （5. 90%） were showed insufficient safety margin on CEUS performed 24 h after RFA. Two of the 9 lesions were proved tumor residual and 7 of the 9 lesions were proved response completely by CECT one month later. The two residual lesions were gave supplementary treatment to achieve sufficient safety margin. The remaining 143 lesions （94.1 %） were showed insufficient safety margin on CEUS performed 24 h after RFA were proved response completely by CECT one month later. Ten of the 152 lesions developed local recurrence after 4-24 months＇ follow up. Multivariate statistical analysis showed that the safety margin and growth pattern were independent prognostic factors for local tumor progression. Conclusion： Assessing the growth manner of the lesion before RFA and evaluating the safety margin after it are important in improving therapeutic effect.