第一肝门区小肝癌的经皮肝穿刺射频消融治疗

目的探讨对于位于第一肝门区的小肝癌行B超引导经皮肝穿刺射频消融(PRFA)治疗的可行性、疗效和应注意的问题。方法2000年4月至2002年10月选择肿瘤位于第一肝门区、≤5cm、病理或临床证实为原发性或继发性肝癌的21例患者进行PRFA治疗。治疗前甲胎蛋白(AFP)阳性者治疗后定期复查AFP。治疗后1个月复查MRI或CT确定肿瘤是否完全坏死,以后每3个月定期复查。Kaplan-Meier法计算“无瘤”生存率和累积生存率。结果AFP转阴率约为78％,MRI或CT显示第一肝门区肿瘤完全凝固坏死率为90．5％(19／21)。0．5、1、1．5、2年无原位复发生存率均为94．7％;0．5、1、1.5、2年无“瘤旁复发”生存率分别为90．0％、77．1％、77．1％和77．1％;0．5、1、1．5、2年总生存率分别为89．2％、82．8％、82．8％和55．2％。胆管狭窄发生率为4．8％。结论第一肝门区小肝癌并非PRFA治疗的禁忌证,只要治疗时穿刺点选择恰当、穿刺路径合理、超声监测下电极展开确切、热凝范围控制恰当,对于第一肝门区小肝癌PRFA是一种行之有效的治疗方法。

Percutaneous radiofrequency ablation for liver cancer located in hepatis

Objective To explore the feasibility,effect and problems of percutaneous radiofrequency ablation (PRFA) performed for small liver cancer located in hepatis. Methods Twenty-one patients,who had small primary or metastatic liver cancer confirmed clinically or pathologically that were located in hepatis and less than 5cm,were performed PRFA between April 2000 and October 2002. All patients were followed up to examine the value of AFP,MRI or CT. Kaplan-Meier estimation was used for the disease-free survival rate and the long-term survival rate. Results The rate of AFP positive down to negative was 77.8%(7/9). The complete necrosis rate was 90.5%(19/21). The peri-tumor recurrence-free survival rates of 0.5-,1-,1.5-,2-year were all 94.7%. The distant recurrence-free survival rates of 0.5-,1-,1.5-,2-year were 90.0%,77.1%,77.1% and 77.1% respectively. The whole survival rates of 0.5-,1-,1.5- and 2-year were 89.2%,82.8%,82.8% and 55.2% respectively. Conclusions Small liver cancer located in hepatis was not the contra-indication of PRFA. If the puncture point and route is selected properly,electrodes outspreaded exactly and the range of heating controlled appropriately,PRFA is an effective method and of less complication rate for small liver cancer located in hepatis. Sometimes,PRFA can be combined with TACE for those tumors of the diameter larger than 3 cm.