经皮肝穿刺射频热凝与肝动脉化疗栓塞联合治疗肝细胞癌

目的：探讨对于无手术指征或考虑手术疗效欠佳的较大肝癌（3－7cm）和位于肝门区的小肝癌先行肝动脉化疗栓塞（TACE）,再行B超引导经皮肝穿刺射频热凝（PRFA）治疗肝癌的意义。方法2000年1月至2001年7月对符合条件的15例肝癌患者先行TACE,而后进行B超引导PRFA治疗,另15例肝癌患者直接给予B超引导PRFA治疗。治疗后定期复查甲胎蛋白（AFP）。1个月后复查MRI或CT确定肿瘤是否完全坏死,以后每2－3个月复查。Kaplan-Meier法计算无瘤生存率和累积生存率。结果：TACE加PRFA组肿瘤完全坏死率86．7％（13／15）,单纯PRFA组为26．7％（4／15）,差异有显著意义。前组AFP转阴率66．7％（6／9）,后组20％（2／10）。前组6个月无瘤生存率100％（13／13）,后组75．0％（3／4）。前组1、1．5、2年的生存率分别为100％、100％和66．7％,后组1和1．5年的生存率分别为80．0％和40．0％,差异有显著意义。结论：对于较大的（＞3cm）、位于肝门区的、边界不清的或较多个瘤灶的肝癌先行TACE,再适时给予PRFA,可以扩大肿瘤坏死范围,增加肿瘤完全坏死率、减少复发、提高生存率。

Percutaneous radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

Objective To assess the significance of the method of percutaneous radiofrequency ablation (PRFA) combined with transcatheter arterial chemoembolization for hepatocellular carcinoma. Methods Thirty patients with hepatocellular carcinoma were divided into PRFA group and TACE+PRFA group between January 2000 and July 2001. All patients were followed up to examine the value of AFP, MRI or CT. Kaplan Meier estimation was used for the analysis of disease free survival and the cumulative survival rate. Results The complete necrosis rates were 86 7% (13/15) and 26.7% (4/15) in the TACE+PRFA group and group PRFA group respectively. The rates of AFP positive down to negative were 66 7%(6/9) for the former and 20% (2/10) for of the latter, and the six month disease free survival rates were 100% (13/13) and 75% (3/4) in the two groups. The 1 , 1 5 and 2 year survival rates of the group TACE+PRFA were 100%, 100% and 66 7% respectively. The survival rates of 1 and 1 5 years of the group PRFA only were 80% and 40%. Conclusions For those hepatocellular carcinomas over 3 cm in size, located in the porta hepatis, or with indistinct boundary or the presence of foci, TACE can be performed first and then followed by PRFA in suitable time. This method can enlarge the necrosis range and increase the rate of complete necrosis of tumors, thereby decrease the recurrence and improve the disease free survival and total survival of patients.