超声引导经皮复合热消融技术治疗中、大肝细胞癌

目的　评估超声引导复合热消融技术治疗中、大肝细胞癌 (HCC)的应用价值。方法在超声引导下经皮采用多针插入、多点能量输出的射频消融 (RFA)或微波消融 (MWA)技术 ,治疗 6 8例HCC患者共 73个肿瘤结节 ,平均直径 (4 5± 1 7)cm (3 1～ 13 0cm) ,经 1 9～ 6 7 6个月 [平均(16 0± 14 8)个月 ]随访 ,检测局部及远期治疗效果。结果　治疗后合并肝包膜下血肿及皮肤烧伤的患者各 1例。肿瘤完全消融率 78 1% (5 7/73) ,2 4 6 % (14 /5 7)的病灶出现局部肿瘤进展 ,远处复发率 5 6 7% (38/6 7) ,1、3、5年生存率分别为 6 2 3%、2 9 6 %、2 1 6 % ,中位生存时间为 18 6个月 (95 %可信区间为 10 9～ 2 6 3个月 )。RFA与MWA在完全消融率、局部肿瘤进展率与远处复发率、生存率方面差异均无显著意义。结论　经皮复合热消融技术治疗不能手术切除的中、大肝细胞癌创伤小 ,可获得良好的局部控制和远期疗效 ,RFA与MWA疗效无明显差异

Ultrasound-guided percutaneous composite thermal ablation technique in treatment of medium and large hepatocellular carcinoma

OBJECTIVE: To evaluate the clinical values of ultrasound-guided percutaneous composite thermal ablation technique in the treatment of medium and large hepatocellular carcinoma (HCC). METHODS: By the composite technique of multiple-needle insertion and multi-point energy application, ultrasound-guided percutaneous radiofrequency ablation (RFA) or microwave ablation (MWA) were employed to treat 68 patients of HCC with tumor nodule > or = 3.1 cm in diameter. There was a total number of 73 tumor nodules, with a mean diameter of (4.5 +/- 1.7) cm (3.1-13.0 cm). Sixty-three patients had single tumor nodule, and the remaining 5 had 2 nodules. With a follow-up time of 1.9 - 67.6 months [(16.0 +/- 14.8) months], the local and long-term efficacy was analyzed. RESULTS: Hepatic subcapsular hematoma were found in 1 patient. And skin burning in 1 patient 1. Complete ablation rate was 78.1% (57/73), local tumor progression was presented in 24.6% tumor nodules (14/57) and distant recurrence developed in 56.7% patients (38/67). The 1-, 3-, 5-years survival rate was 62.3%, 29.6% and 21.6%, respectively, with a median survival time of 18.6 months, (95% confidence interval: 10.9 months, 26.3 months). There were no remarkable differences in complete ablation rate, local tumor progression, distant recurrence rate and survival rate between RFA and MWA. CONCLUSIONS: By the composite ablation technique, ultrasound-guided percutaneous thermal ablation was effective in treating medium and large unresectable HCC. And the advantage is minimal invasiveness. RFA and MWA had no marked differences in terms of therapeutic efficacy.