无水酒精注射联合射频消融治疗射频消融困难部位的肝癌

目的:探讨无水酒精注射联合射频消融治疗射频消融困难部位肝癌的疗效.方法:回顾性分析靠近结肠、胆囊、大中血管、膈肌等存在射频困难区肝癌患者31例,在采用射频治疗后残余病灶行无水酒精补充治疗,评价病灶坏死率及术后并发症.结果:31例患者的47个病灶当中共有33个病灶位于射频困难部位,肿瘤完全坏死率为72.7%(24/33).无腹腔内出血,胆囊穿孔,结肠穿孔等严重并发症出现.结论:射频困难部位的肝癌病灶采用射频补充无水酒精注射治疗效果良好,未见严重的射频或酒精注射相关并发症发生,可在肝癌的综合治疗中推广应用.     

无水酒精注射联合射频消融治疗射频消融困难部位的肝癌

目的：探讨无水酒精注射联合射频消融治疗射频消融困难部位肝癌的疗效。方法：回顾性分析靠近结肠、胆囊、大中血管、膈肌等存在射频困难区肝癌患者31例,在采用射频治疗后残余病灶行无水酒精补充治疗,评价病灶坏死率及术后并发症。结果：31例患者的47个病灶当中共有33个病灶位于射频困难部位,肿瘤完全坏死率为72.7%（24/33）。无腹腔内出血,胆囊穿孔,结肠穿孔等严重并发症出现。结论：射频困难部位的肝癌病灶采用射频补充无水酒精注射治疗效果良好,未见严重的射频或酒精注射相关并发症发生,可在肝癌的综合治疗中推广应用。     

Combined use of percutaneous ethanol injection and radiofrequency ablation for the effective treatment of hepatocelluar carcinoma

Radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) therapy are currently used for the treatment of hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the usefulness of combination therapy of PEI and RFA (PEI-RFA). Seventy-three patients with biopsy-proven HCC and liver cirrhosis underwent RFA after a bolus injection of ethanol into HCC. The volume of coagulated necrosis in the liver caused by PEI-RFA was estimated and compared with that by RFA alone. Coagulated necrosis areas in the liver of patients treated with PEI-RFA were significantly larger than those of patients treated with RFA alone. In PEI-RFA group, the volume of coagulated necrosis was significantly correlated with the amounts of ethanol injected into HCC. No major complications were observed during and after the PEI-RFA treatment. These results indicate that PEI-RFA is more effective than RFA alone and can make dramatic improvement of therapeutic effects in RFA therapy for HCC with fewer sessions of treatments. Therefore, PEI-RFA is considered to be a practical and promising option and may open up new avenues for the treatment of HCC.     

肝动脉栓塞化疗后射频消融联合酒精消融对原发性肝癌的疗效评价

目的　探讨肝动脉栓塞化疗(TACE)后,CT导向下射频消融(RFA)联合无水乙醇消融(PEI)对原发性肝癌(HCC)的治疗效果。方法　经病理、AFP或典型影像学诊断证实的HCC 1 5 0例,每例肝内的病灶数目<3个,病灶大小3.1～7.9cm ,平均直径5 .5cm。全部患者按就诊单双日分为对照组和联合组。对照组74例,TACE后2周行单纯RFA ;联合组76例,TACE后2周行射频消融,间隔2 0～30d后再行PEI。结果　对照组的完全坏死率为75 .8%,联合组为89.5 %,两组间差异有统计学意义(P <0 .0 5 )。结论　HCC患者经TACE后,行CT导向下RFA联合PEI的疗效明显优于单纯RFA。     

Transarterial Chemoembolization Monotherapy in Combination with Radiofrequency Ablation or Percutaneous Ethanol Injection for Hepatocellular Carcinoma

Purpose: To evaluate whether combined transarterial chemoembolization (TACE) with radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI) for hepatocellular carcinoma (HCC) have superior efficacy to transarterial chemoembolization (TACE) alone a retrospective review was conducted. Methods: During January 2009 to March 2013, 108 patients with hepatocellular carcinoma underwent TACE or combined therapies (TACERFA or TACEPEI). The long-term survival rates were evaluated in those patients by various statistical analyses. Results: The cumulative survival rates in the combined TACERFA/PEI group were significantly superior to those in the TACE alone group. When the comparison among the groups was restricted to patients with two or three tumors fulfilling the Milan criteria, significantly greater prolongation of survival was observed in the combined TACE RFA/PEI group than in the RFA/PEI alone group. Conclusions: In terms of the effect on the survival period, combined TACE RFA/PEI therapy was more effective than TACE monotherapy, and also more effective than PEI or RFA monotherapy in cases with multiple tumors.     

Time-lag performance of radiofrequency ablation after percutaneous ethanol injection for the treatment of hepatocellular carcinoma

We have previously reported that the combination therapy of percutaneous ethanol injection and radiofrequency ablation (PEI-RFA) was more effective than RFA alone to induce wider coagulated necrosis for the treatment of hepatocellular carcinoma (HCC). In the present study, the effect of time-lag performance of RFA after PEI was evaluated under the same ablation condition as PEI-RFA by analyzing the volume of coagulated necrosis, the energy requirement for ablation and the amount of ethanol injected into HCC. The comparative study between time-lag PEI-RFA and no time-lag PEI-RFA showed that the total energy requirement and the energy requirement per unit volume for whole and marginal coagulated necrosis were significantly smaller in the time-lag group than in the no time-lag PEI-RFA group. In time-lag PEI-RFA, the volume of coagulated necrosis induced positively correlated with the amount of ethanol injected into HCC as previously observed in PEI-RFA treatment. These results suggest that time-lag PEI-RFA can induce comparable coagulated necrosis with a smaller energy requirement than no time-lag PEI-RFA, and that time-lag PEI-RFA is likely to be less invasive than no time-lag PEI-RFA for inducing comparable coagulated necrosis. Thus, time-lag performance of RFA after PEI may make RFA treatment more effective and less invasive for the treatment of patients with HCC.     

Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome?: Seeding risk for percutaneous approach of HCC

BACKGROUND: Tumour biopsy is usually considered mandatory for patient management by oncologists. Currently percutaneous ablation is used therapeutically for cirrhotic patients with small hepatocellular carcinoma (HCC), not suitable for resection or waiting for liver transplantation. However malignant seeding is a recognized complication of both diagnostic and therapeutic procedures in patients with HCC. Although percutaneous therapy whether with or without biopsy of a suspected HCC nodule may minimize the risk of seeding, this has not been confirmed. AIM: To evaluate the risk of seeding, defined as new neoplastic disease occurring outside the liver capsule, either in the subcutaneous tissue or peritoneal cavity following needle biopsy and/or local ablation therapy (LAT). METHODS: A literature search resulted in 179 events in 99 articles between January 1983 and February 2007: 66 seedings followed liver biopsy, 26 percutaneous ethanol injection (PEI), 1 microwave, 22 radiofrequency ablation (RFA), and 64 after combined biopsy and percutaneous treatment (5 microwave; 33 PEI; 26 RFA). RESULTS: In 41 papers specifying the total number of patients biopsied and/or treated, the median risk of seeding was 2.29% (range 0-11%) for biopsy group; 1.4% (1.15-1.85%) for PEI when used with biopsy and 0.61% (0-5.56%) for RFA without biopsy, 0.95% (0-12.5%) for RFA with biopsy and 0.72% (0-10%) for liver nodules (including non-HCC nodules) biopsied and ablated. CONCLUSION: Risk of seeding with HCC is substantial and appears greater with using diagnostic biopsy alone compared to therapeutic percutaneous procedures. This risk is particularly relevant for patients being considered for liver transplantation.     

Radiofrequency ablation and percutaneous ethanol injection in patients with unresectable hepatocellular carcinoma--a comparative study using Japan Integrated Staging Score (JIS score) system

The patients were classified according to the Japan Integrated Staging (JIS) score and a comparison examination of the long-term therapeutic response of 149 unresectable hepatocellular carcinomas: 90 of them given percutaneous ethanol injection (PEI), and 59 of them given radiofrequency ablation (RFA) who were diagnosed with 3 cm or less in diameters of tumor and less than three nodules, or 5 cm or less single nodule, was carried out in retrospective. To all the tumors exceeding 3 cm in diameter, we added transcatheter arterial embolization (TAE) prior to PEI or RFA. Ninety four percent of PEI cases and 25% of RFA cases received a combination therapy with TAE, respectively. The three-year survivals were 86%, 76%, and 56% in PEI and 96%, 83%, and 68% in RFA for JIS-0, 1, and 2, respectively. The five-year survivals were 69% and 53% in PEI and 95% and 83% in RFA for JIS-0 and 1, respectively. The significant difference in the probability of survival was not confirmed among both treatments. We conclude that the combination therapy, such as combined use of TAE, PEI and RFA as local treatment, can expect almost equivalent effectiveness for unresectable hepatocellular carcinoma.     

肝癌射频消融术后联合替吉奥节拍化疗的疗效评价

目的 探讨肝癌患者射频消融术后口服低剂量替吉奥的节拍化疗临床疗效。方法 选择接受射频消融术的肝癌患者,按照术后是否口服替吉奥进行节拍化疗分为RFA+替吉奥组和RFA对照组,回顾性分析两组患者术后18个月内的临床疗效,评价其原发肿瘤控制率和无疾病进展时间。结果 随访观察显示,术后9个月RFA+替吉奥组的肿瘤控制率为93.3%,RFA对照组肿瘤控制率为73.4%,差异有统计学意义(P=0.038);随访18个月内,RFA+替吉奥组无疾病进展时间中位数为16.25个月,RFA对照组无疾病进展时间中位数降低为12.25个月(P＜0.001);1年无疾病进展率在RFA对照组为53.3%,显著低于RFA+替吉奥组83.3%(P=0.012)。两组均无治疗相关性死亡,主要并发症发生率为13.3%。结论 射频消融术后进行替吉奥节拍化疗治疗肝癌可以减缓肿瘤进展,延长肝癌患者的无疾病进展时间。     

Outcome of regional and local ablative therapies for hepatocellular carcinoma: a collective review.

BACKGROUND: Transcatheter arterial (chemo) embolization (TACE), cryoablation (CA) and percutaneous ethanol injection (PEI) were the first regional and local ablative techniques that came into use for irresectable HCC. Radiofrequency ablation (RFA) and interstitial laser coagulation (ILC) followed and have now evolved rapidly. It would not be ethical to compare resection with ablation in patients well enough to undergo major surgery. Therefore, hepatic resection and hepatic transplantation remain the only curative treatment options for HCC. METHODS: On the basis of a Medline literature search and the authors' experiences, the principles, current status and prospects of TACE and local ablative techniques in HCC are reviewed. RESULTS: Complete tumour necrosis can be achieved in 60-100% of patients treated with PEI (70-100%), cryoablation (60-85%), RFA (80-90%) or ILC (70-97%). After TACE significant tumour response is achieved in 17-61.9% but complete tumour response is rare (0-4.8%) as viable tumour cells remain after TACE. Five-year survival rates are available for TACE (1-8%), PEI (0-70%) and cryoablation (40%). Only PEI and RFA were compared in one RCT. RFA was associated with fewer treatment sessions and a higher complete necrosis rate. Furthermore, all techniques are associated with low morbidity and mortality, but cryoablation seems to be associated with a higher morbidity rate. CONCLUSION: TACE has shown to be a valuable therapy with survival benefits in strictly selected patients with unresectable HCC. RFA and PEI are now considered as the local ablative techniques of choice for the treatment of, preferably small, HCC. When tumours are located close to bile ducts or large vessels, PEI remains a valuable therapy. Completeness of ablation can be more easily monitored during cryoablation and another advantage of cryoablation is the possibility of edge freezing. The results of ILC are comparable to RFA with only few side effects and high tumour response rates.     

Radiofrequency ablation for hepatocellular carcinoma

We performed radiofrequency ablation (RFA) for 14 patients with hepatocellular carcinoma (HCC) between May 2001 and March 2002. The underlying hepatic disease was type C liver cirrhosis in all patients. Seven patients had a solitary lesion, and 7 patients had multiple lesions. RFA was chosen for the primary tumor in 5 cases and for a recurrent tumor in 9 cases. Three cases of well differentiated HCC were included. Transcatheter arterial embolization (TAE) was performed in 10 cases simultaneously. Nine patients received RFA under general anesthesia (open laparotomy: 5 cases, transthoracic: 1 case, CT guided: 2 cases, US guided: 1 case) and 5 patients under local anesthesia (CT guided: 2 cases, US guided: 3 cases). RFA was performed for 12 minutes in each session and the mean number of sessions per patient was 3.2. Excellent ablation was achieved in all cases according CT evaluation, and no additional therapy was needed. No recurrences have been found in any cases so far. RFA for HCC achieved excellent therapeutic effect in combination with other therapies as multimodal therapy.     

Combined radiofrequency ablation and ethanol injection versus repeat hepatectomy for elderly patients with recurrent hepatocellular carcinoma after initial hepatic surgery

Purpose: To retrospectively compare the efficacy and safety of combined radiofrequency ablation and percutaneous ethanol injection (RFA–PEI) with repeat hepatectomy for elderly patients with initial recurrent hepatocellular carcinoma (HCC) after hepatic surgery.

Methods: From January 2009 to June 2015, 105 elderly patients (≥70?years) who underwent RFA–PEI (n?=?57) or repeated hepatectomy (n?=?48) for recurrent HCC?≤?5.0?cm were included in the study. The overall survival (OS) and recurrence-free survival (RFS) were analysed with the Kaplan–Meier method and compared by the log-rank test. Non-tumour-related death, complications and hospital stays were assessed. Univariate and multivariate analyses were performed to identify the prognostic significance of the variables in predicting the OS and RFS.

Results: OS rates were 78.2%, 40.8% and 36.7% at 1, 3 and 5?years after RFA–PEI and 76.3%, 52.5% and 42.6% after repeat hepatectomy, respectively (p?=?0.413). Correspondingly, the 1-, 3- and 5-year RFS rates after RFA–PEI and repeat hepatectomy were 69.5%, 37.8%, 33.1% and 73.1%, 49.7%, 40.7%, respectively (p?=?0.465). Non-tumour-related deaths in the RFA–PEI group (2/57) were significantly fewer than those in the repeat hepatectomy group (10/48) (p?=?0.016). RFA–PEI was superior to repeat hepatectomy regarding the major complication rates and length of in-hospital stay (both p?p?=?0.037) and RFS (HR?=?1.866, 95% CI?=?1.064–3.274, p?=?0.030).

Conclusion: RFA–PEI provides comparable OS and RFS to repeat hepatectomy for elderly patients with small recurrent HCC after hepatectomy but with fewer non-tumour-related deaths, major complications and shorter hospital stays.     

Radiofrequency ablation for hepatocellular carcinoma and metastatic liver tumors: a comparative study

BACKGROUND: This study compared the effectiveness of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and liver metastases. METHODS: We compared the outcomes of 240 patients with HCC and 44 patients with liver metastases treated with RFA. Data were prospectively collected and retrospectively analyzed. Effects of different variables on recurrences were studied. RESULTS: A total of 406 tumor nodules were treated. The median size of the largest ablated tumor was 2.5 cm, and the median tumor number was 1. Complete tumor ablation was achieved in 91.2%. Local recurrence rate was 15.4% after a median follow-up of 24.5 months. There was no significant impact of tumor pathology on local recurrence. However, patients with liver metastasis had higher extrahepatic recurrence rate (P = 0.019) and shorter disease-free survival (P = 0.007). Patients with multiple tumors had higher local (P = 0.047) and extrahepatic (P = 0.019) recurrence rates than those with a solitary tumor. Tumor size had an impact on local recurrence rate only in patients with liver metastasis with a higher rate in those with tumor > 2.5 cm in diameter (P = 0.028). CONCLUSIONS: Tumor pathology does not appear to have a significant impact on local recurrence rates. RFA is effective in local tumor control for both HCC and liver metastasis.     

No-touch射频消融术治疗小肝癌的安全性和短期疗效

目的:探讨No-touch射频消融术治疗小肝癌患者的安全性和短期疗效。方法:本研究共纳入65例信阳市中心医院小肝癌患者，23例采用No-touch射频消融术治疗，42例采用常规射频消融术（radiofrequency ablation，RFA）治疗。比较和分析治疗并发症和无瘤生存率。结果:两组间基线混杂因素无显著差异。No-touch射频消融术的消融体积显著高于常规射频消融术（P=0.043），但两种技术的剩余肝脏体积和治疗并发症相同（分别为P=0.670和P=1.000）。Kaplan-Meier生存曲线显示:No-touch射频消融组的总体生存率显著高于常规组（P=0.048）。结论:No-touch射频消融术比传统射频消融术具有更高的短期总体生存率，而与传统射频消融术一样安全。     

不宜切除小肝癌射频与射频联合全身化疗的随机对照初步研究

目的 研究射频联合化疗治疗不宜切除小肝癌的临床安全性以及对肝癌原位复发率的影响。方法 ≤3cm不宜切除的原发性肝癌患者38例,其中27例1年随访资料完整。根据射频与射频联合全身化疗的随机分组方案入选标准,射频组12例,射频联合全身化疗组15例。在超声引导下行多电极射频治疗。化疗方案为：表阿霉素50mg,d1,3,静推;顺铂40mg,d1,3,静滴;氟脲嘧啶500mg,d1,2,3,静滴。观察患者术后1,4,7d的肝功能、血常规和并发症,术后1,6,12个月复查GT(增强),评价两组患者治疗的安全性及原位复发率。结果 两组射频术后1个月,均无原位复发。射频联合全身化疗组6,12个月的原位复发率较单射频组明显下降,差异有显著性。两组均无严重并发症,肝功能、血常规变化差异无显著性。结论 对≤3cm不宜切除的原发性肝癌患者,射频联合全身化疗是安全的,并能降低肝癌原位复发率。     

Population-based matching comparison between radiofrequency ablation and percutaneous ethanol or acetic acid injection for hepatocellular carcinoma

BackgroundLoco-regional therapies are evolving for hepatocellular carcinoma (HCC) treatment. Radiofrequency ablation (RFA) has changed the landscape in treating HCC; however, percutaneous ethanol or acetic acid injection (PEI/PAI) remains a widely used and easily performed technique by experienced clinicians. Nevertheless, the effectiveness of RFA compared to that of PEI/PAI remains unclear.MethodsRecords of 73,136 patients with newly diagnosed HCC between 2007 and 2013 were drawn from the Taiwan Cancer Registry. The primary outcome measures were the overall survival and local recurrence-free survival. Propensity score matching (PSM) was performed to compare the effectiveness of RFA and PEI. Median follow-up time was 61.6 months (36–120 months).ResultsAfter PSM, 4496 patients diagnosed with stage I-III HCC, who were initially treated with RFA (3372 patients) or PEI/PAI (1124 patients), were assessed. Compared to PEI/PAI, patients treated with RFA had better 5- and 9-year overall survival, cancer-specific survival, disease-free survival, and local recurrence-free survival. Median overall survival and recurrence-free survival of patients treated with RFA vs PEI/PAI were 61.5 vs 41.9 months and 72.1 vs 45.2 months, respectively. Multivariate Cox model analysis revealed that, except for patients with high cell grade or advanced stage, RFA resulted in better overall survival (HR: 0.74, 95% CI 0.68–0.81, P < 0.001) and local recurrence-free survival (HR: 0.69, 95% CI 0.63–0.75, P < 0.001) than PEI/PAI.ConclusionsRFA provides advantages over conventional PEI/PAI for HCC. Considering technological advances in instruments, loco-regional therapies for HCC can be employed in carefully selected patients.     

射频消融治疗原发性肝癌的生命质量对比评价

背景与目的以往对原发性肝癌(hepatocellularcarcinoma,HCC)各种治疗疗效的评价主要从治愈率、生存率和生存时间方面进行,近年来生命质量(qualityoflife,QOL)研究倍受关注,能较全面地反映肝癌患者体能恢复状况和切身感受而被广泛应用于癌症、慢性病的疗效评价。目前对于经皮射频消融(radiofrequencyablation,RFA)、经动脉插管栓塞化疗(transcatheterhepaticarterialchemo-embolization,TACE)治疗意义的评价大多关注局部肿瘤灭活率及患者生存率,而对治疗后患者生命质量的研究尚不多见。本研究从患者整体角度对比评估原发性肝癌经皮射频消融治疗后患者的生命质量。方法采用国内肝癌特异性生命质量量表(QOL-LCV2.0),对80例HCC经RFA治疗后QOL进行评定;并与同期40例经动脉插管栓塞化疗(TACE组)以及TACE RFA(联合组)40例分别进行比较。3组患者在年龄、性别、临床分期等方面分布均衡,无明显差异。结果RFA组的QOL总分中位数(168.6)高于TACE组(146.8),差异有显著性(P=0.025);RFA组和联合组在症状/副作用领域的得分中位数45.5、46.0,分别优于单纯TACE组38.1(P<0.01);RFA组躯体功能领域得分呈略高于TACE组的趋势。患者的年龄、收入、治疗后Child-Pugh分级、治疗后新生/复发率、并发症等方面与患者生命质量相关。TACE组和联合组于治疗后Child-Pugh分级提高的比例分别高于RFA组;TACE组新生/复发的比例明显高于RFA组。RFA组的1年、2年和3年生存率(92.8%、89.3%和76.5%)与联合治疗组(94.1%、87.4%、60.0%)比较无统计学差异,但高于TACE组(74.3%、48.2%、48.2%)。结论RFA治疗肝癌,多数患者可获得较好的疗效,严重的副作用少。TACE与RFA联合治疗与单纯TACE相比,可减少患者肝功能损伤,有利于提高原发性肝癌患者的生命质量。     

Midterm outcomes in patients with intermediate‐sized hepatocellular carcinoma

BACKGROUND:

To improve the efficacy of radiofrequency ablation (RFA) for the treatment of intermediate‐sized hepatocellular carcinomas (HCCs), the authors compared RFA combined with transcatheter arterial chemoembolization (TACE) to RFA alone.

METHODS:

The authors randomly assigned 37 patients with solitary HCCs (diameter, 3.1‐5.0 cm in the greatest dimension) to 2 groups: the TACE‐RFA group, in which the patients received TACE followed by RFA on the same day, and the RFA group, in which the patients received only RFA.

RESULTS:

Technical success was achieved after 1.4 ± 0.5 RFA sessions in the RFA group and after 1.1 ± 0.2 RFA sessions in the TACE‐RFA group (P < .01). The mean diameters of the longer and shorter axes of the RFA‐induced ablated areas were 50 ± 8.0 mm and 41 ± 7.1 mm, respectively, in the RFA group and 58 ± 13.2 mm and 50 ± 11.3 mm, respectively, in the TACE‐RFA group; the mean diameters of the shorter axes were significantly different (P = .012). The rates of local tumor progression at the end of the third year in the RFA and TACE‐RFA groups were 39% and 6%, respectively (P = .012). The 3‐year survival rates of the patients in the RFA and TACE‐RFA groups were 80% and 93%, respectively (P = .369).

CONCLUSIONS:

In patients with intermediate‐sized HCCs, RFA combined with TACE is more effective than RFA alone for extending the ablated area in fewer treatment sessions and for decreasing the local tumor progression rate. Cancer 2010. © 2010 American Cancer Society.     

超声引导下经皮激光消融与射频消融治疗微小肝细胞癌的疗效对比

目的：通过与超声引导下经皮射频消融（RFA）比较，观察超声引导下经皮激光消融（LA）治疗微小肝细胞癌（HCC）的临床疗效。方法回顾性分析54例微小 HCC 患者的临床资料，按照治疗方法的不同将其分为 LA 组（n ＝27）和 RFA 组（n ＝27）。LA 组患者接受超声引导下 LA 治疗，RFA 组接受超声引导下 RFA 治疗，观察近期疗效及不良反应，随访患者的肿瘤局部控制率和无进展生存期（PFS）。结果LA 组和 RFA 组患者治疗后的总有效率分别为81．48％、77．78％，差异无统计学意义（χ2＝0．11，P ＝0．74）；两组患者1年肿瘤局部控制率分别为77．78％、51．85％，差异有统计学意义（χ2＝14．74，P ＝0．00）；两组患者中位 PFS 分别为（12．52±6．57）个月和（8．67±5．13）个月，差异有统计学意义（χ2＝4．70，P ＝0．03）。LA 组和 RFA 组治疗后出现的不良反应如穿刺区域疼痛（40．74％∶33．33％；χ2＝0．32，P ＝0．57）、腹腔出血（7．41％∶11．11％；P ＝0．64）、胆道出血（0∶3．70％；P ＝0．31）、胆漏（7．41％∶14．81％；P ＝0．39）、腹腔感染（3．70％∶11．11％；P ＝0．30）的差异均无统计学意义。结论与 RFA 比较，LA 可提高微小 HCC 患者的肿瘤局部控制率，并延长患者的 PFS，具有一定的临床应用价值和前景。     

The validity of radiofrequency ablation for hepatocellular carcinoma

Radiofrequency ablation therapy (RFA) has now become the mainstream percutaneous local treatment for hepatocellular carcinoma (HCC). RFA is superior to both percutaneous ethanol injection (PEI) and percutaneous microwave coagulation therapy (PMCT) because of the large coagulation area obtained by a single session of RF ablation. In addition, the local recurrence rate after RFA is lower than that after PEI. Recently, to improve tumor ablation efficacy, several devices have been reported. We also designed RFA with balloon occlusion of the hepatic artery (balloon-occluded RFA, BoRFA). The coagulation area obtained by BoRFA was significantly larger than that obtained by standard RFA. In Japan, the results for RFA remain insufficient because of the short follow-up periods after treatments. Within a few years, we expect to clarify the indications for RFA treatment for HCC and the choice between RFA and other local treatments.