343例肝恶性肿瘤射频消融疗效及并发症

目的:总结射频消融(radiofrequency ablation,RFA)对肝恶性肿瘤的治疗效果,探讨并发症类型及处理措施.方法:对343例778个肝恶性肿瘤行582人次超声引导RFA治疗.其中原发性肝癌(HCC)212例,448个癌灶,肿瘤最大径平均4.0 cm,根据国际抗癌协会的肿瘤分期,其中63例(29.7%)为Ⅰ～Ⅱ期,149例(70.3%)为Ⅲ～Ⅳ期(含43例手术切除后复发癌).肝转移癌(MLC)131例,330个癌灶,癌灶直径平均为3.9 cm,原发灶69.5%(91例)来自胃肠道.治疗原则为消融范围超过癌周0.5～1.0 cm;对较大肝肿瘤,采用较规范的计算方案指导射频治疗.治疗中密切观察图像异常改变,监测生命体征,以便及时发现出血及周围损伤.治疗后24 h内或1个月后增强CT检查肿瘤无活性为治疗成功.随访时间为2～62个月.结果:射频治疗成功率HCC为95.5%(428/448灶),MLC为96.4%(318/330灶);局部复发率分别为8.5%(38/448灶),11.8%(39/330灶).共有138例(40.2%)由于肿瘤复发或新生而进行2～11次治疗.随访343例1年、2年和3年的生存率,HCC分别为87.7%,67.4%和56.8%,其中63例早期癌分别为92.9%,82.8%,74.5%;MLC分别为81.6%,50.8%,27.2%.本组并发症的发生率占2.4%(14/582人次),多发生于治疗中或治疗后即刻,主要为机械性损伤、热损伤等,分别为出血5例,肠穿孔1例,邻近脏器结构损伤5例,胆汁瘘2例,皮肤烫伤1例.结论:RFA作为一种肝肿瘤的局部微创治疗方法,对早期肝癌可获得手术治疗效果;对中晚期肝癌、肝癌术后复发、肝转移癌等临床治疗困难的病例,也可提供有效而相对安全的治疗手段.重视并发症的表现并采用相应的对症处理措施,可提高患者生存质量,延长生存期.

Efficacy of radiofrequency ablation of 343 patients with hepatic tumor and the relevant complications

OBJECTIVE: To investigate the treatment efficacy of radiofrequency ablation (RFA) of hepatic tumors and the relevant complications. METHODS: A total of 343 patients with 778 hepatic tumors underwent ultrasound-guided RFA (582 procedures). There were 212 cases of hepatic cellular carcinoma (HCC) with 448 tumors, and the average largest diameter was 4.0 cm. Of all the patients, 63 (29.7%) were in the stage of I-II (UICC Systems) and 149 (70.3%) in stage of III-IV (including 43 patients with tumor recurrence after surgical resection). There were 131 cases of metastatic liver carcinoma (MLC), with 330 metastases in the liver, the average diameter was 3.9 cm, and the liver metastases of 91 patients (69.5%) came from gastrointestinal tract. The patients were treated using the relatively standard protocol. Crucial attention must be paid to monitoring the abnormal changes in ultrasound images as well as the vital signs of the patients to find the possible hemorrhage and peripheral structure injury in time. The tumors were considered ablated successfully if no viability was found on enhanced CT within 24 hours or 1 month after RFA. The patients were followed up for 2-62 months. RESULTS: The ablation success rate for HCC was 95.5% (428/448 tumors), and the rate for MLC was 96.4% (318/330 tumors). The local tumor recurrence rates for HCC and MLC were 8.5% (38/448 tumors) and 11.8% (39/330 tumors), respectively. A total of 138 patients (40.2%) underwent repeated ablations for 2-11 times because of tumor recurrence or metastasis. The first, second and third years survival rates were 87.7%, 67.4% and 56.8% for HCC patients, 81.6%, 50.8% and 27.2% for MLC patients, respectively. The survival rate from 63 early-stage HCC patients were 92.9%, 82.8% and 74.5%, respectively. The major complication rate in this study was 2.4% (14 of 582 procedures). The complications which consisted of mechanical and thermal injuries usually occurred during or shortly after the RFA treatment. There were 5 hemorrhages, 1 colon perforation, 5 injuries of adjacent structures, 2 bile leakages and 1 skin burn. CONCLUSION: RFA, as a minimally invasive local treatment, has become an effective and relatively safety alternative for the patients of hepatic tumors, even of advanced live tumor, tumor recurrence, liver metastases which are unresectable or difficult to treat with traditional therapies. Knowledge about possible complications and their control may increase the treatment efficacy and help to promote the use of RFA technique.