Local recurrence is an important prognostic factor of hepatocellular carcinoma

AIM: To clarify the importance of complete treatment by PEIT. METHODS: A total of 140 previously untreated cases of HCC were enrolled in this study from 1988 to 2002. The inclusion criteria were: a solitary tumor less than 4 cm in diameter or multiple tumors, fewer than four in number and less than 3 cm in diameter, without extrahepatic metastasis or vessel invasion. As general principles for the treatment of HCC, the patients underwent transcatheter arterial chemoembolization (TACE) prior to PEIT. After the initial treatment of the patients, ultrasonography and computed tomography were performed, and measurement of serum levels of afetoprotein (AFP) was determined. When tumor recurrences were detected, PEIT and/or TACE were repeated whenever the hepatic functional reserve of the patient permitted. We then analyzed the variables that could influence prognosis, including tumor size and number, the serum levels of AFP, the parameters of hepatic function (albumin, bilirubin, ALT, hepaplastin test, platelet number, and indocyanine green retention at 15 min [ICG-R15]), combined therapy with TACE, distant recurrence, and local recurrence. RESULTS: Univariate analysis identified the ICG test, serum levels of AFP and albumin, tumor size and number, and local recurrence, but not distant recurrence, as significant prognostic variables. In multivariate analysis using those five parameters, the ICG test, tumor size, tumor number, and local recurrence were identified as significant prognostic factors. In both univariate and multivariate analyses, the relative risk for the ICG test was the highest, followed by local recurrence. CONCLUSION: We found that local recurrence is an independent prognostic factor of HCC, indicating that achieving complete treatment for HCC on first treatment is important for improving the prognosis of patients with HCC.     

TACE联合射频消融治疗原发性肝癌患者疗效研究

目的 观察采用肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗原发性肝癌(PLC)患者的疗效。方法 2016年3月～2018年3月我院收治的PLC患者108例,采用随机数字表法将患者分为联合组和TACE组,每组54例。两组患者均接受TACE治疗,其中54例在TACE治疗的基础上联合RFA治疗。随访观察临床疗效和生存率。结果 联合组有效率为77.8%,疾病控制率为87.0%,显著高于TACE组的50.0%和70.4%(P＜0.05);治疗后,联合组血清总胆红素和甲胎蛋白水平分别为(24.0±6.7)μmol/L和(135.7±15.6)μg/L,显著低于TACE治疗组【分别为(28.3±8.2)μmol/L和(226.5±18.2)μg/L,P＜0.05);在治疗期间,联合组不良反应发生率为48.2%,与TACE组的51.9%比,差异无统计学意义(P＞0.05);联合组1 a生存率为75.0%(39/52),显著高于TACE组的47.2%(25/53),差异有统计学意义(x²=8.542,P=0.003)。结论 采用TACE联合RFA治疗PLC患者安全有效,可提高近期生存率,值得进一步研究。     

经导管肝动脉化疗栓塞联合射频消融治疗原发性肝癌患者临床疗效评价*

目的 评价经导管肝动脉化疗栓塞（TACE）与射频消融（RFA）联合治疗原发性肝癌患者的临床疗效。方法 采用随机数字表法将60例原发性肝癌患者分为联合组30例和TACE组30例,分别给予TACE联合RFA或TACE治疗,对比分析两组患者的近期和远期临床疗效。结果 联合组完全缓解和部分缓解率分别为26.7%和50.0%,显著高于TACE组的6.7%和23.3%,差异均具有统计学意义（P<0.05）;联合组患者生存时间为（2.86±0.48）年,显著长于TACE组的（0.93±0.27） 年,差异具有统计学意义（P<0.05）;联合组患者治疗后1年、2年、3年血清AFP水平分别为（475.4±200.7） μg/L、（416.4±229.0） μg/L、（320.4±243.5） μg/L,显著低于TACE组的（639.1±190.9） μg/L、（623.4±234.6） μg/L、（674.4±300.2） μg/L,差异均具有统计学意义（P<0.05）;联合组患者1 a、2 a、3 a生存率分别为86.7%、66.7%、56.7%,显著高于TACE组的46.7%、26.7%、10.0%,差异均具有统计学意义（P<0.05）。结论 TACE与RFA联合治疗原发性肝癌患者,临床疗效显著。     

Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma

AIM: To compare radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA monotherapy in hepatocellular carcinoma (HCC). METHODS: We searched PubMed, Medline, Embase and Chinese databases (CBMdisc and Wanfang data) for randomized controlled trails comparing RFA plus TACE and RFA alone for treatment of HCC from January 2000 to December 2012. The overall survival rate, re-currence-free survival rate, tumor progression rate, and safety were analyzed and compared. The analysis was conducted on dichotomous outcomes and the standard meta-analytical techniques were used. Pooled odds ratios (ORs) with 95%CIs were calculated using either the fixed-effects or random-effects model. For each meta-analysis, the χ2 and I2 tests were first calculated to assess the heterogeneity of the included trials. For P<0.05 and I 2>50%, the assumption of homogeneity was deemed invalid, and the random-effects model wasused; otherwise, data were assessed using the fixed-effects model. All statistical analysis was conducted us-ing Review manager (version 4.2.2.) from the Cochrane collaboration. RESULTS: Eight randomized controlled trials were identified as eligible for inclusion in this analysis and included 598 patients with 306 treated with RFA plus TACE and 292 with RFA alone. Our data analysis indicated that RFA plus TACE was associated a sig-nificantly higher overall survival rate (OR 1-year=2.96, 95%CI: 1.84-7.74, P<0.001; OR 2-year=3.72, 95%CI: 1.24-11.16, P=0.02; OR 3-year=2.65, 95%CI: 1.81-3.86, P<0.001) and recurrence-free survival rate (OR 3-year=3.00, 95%CI: 1.75-5.13, P<0.001; OR 5-year=2.26, 95%CI: 1.43-3.57, P=0.0004) vs that of RFA alone. The tumor progression rate in patients treated with RFA alone was higher than that of RFA plus TACE (OR=0.60, 95%CI: 0.42-0.88, P=0.008) and there was no significant difference on major complications between two different kinds of treatment (OR=1.20, 95%CI: 0.31-4.62, P=0.79). Additionally, the meta-analysis data of subgroups revealed that the     

肝动脉化疗栓塞联合经皮射频治疗老年中晚期肝癌的疗效

目的 分析肝动脉化疗栓塞（TACE）联合经皮射频消融（RFA）治疗老年中晚期原发性肝癌（HCC）的疗效,为HCC的临床治疗提供参考.方法 按照随机数字表法将80例患者分为TACE联合RFA治疗组（观察组）和RFA治疗组（对照组）,比较两组治疗效果.结果 观察组肿瘤瘤体缩小率高于对照组,两组比较,差异具有统计学意义（P＜0.05）;甲胎蛋白下降超过50％者,观察组（85.7％）与对照组（55.6％）比较差异具有统计学意义（P＜0.05）.两组不良反应发生情况差异无统计学意义（P＞0.05）;术后24个月随访,观察组生存率27例（67.5％）,对照组生存率17例（42.5％）,两组比较差异具有统计学意义（P＜0.05）.结论 HCC患者对TACE联合RFA治疗的耐受性较好,联合治疗的安全性和可行性较好.     

Comparison of therapeutic effectiveness of combined interventional therapy for 1126 cases of primary liver cancer

AIM: To verify the effect of combined interventional therapy for hepatocellular carcinoma (HCC). METHODS: The clinical data of 1126 HCC patients who received combined interventional therapy for transcatheter arterial chemoembolization (TACE) before or after hepatectomy, TACE and radio-frequency ablation (RFA), Chinese medicine treatment and biotherapy after TACE or transcatheter arterial infusion (TAI), were reviewed according to the results of their liver function, alpha-fetoprotein, image data, color-ultrosonography finding and survival rate. RESULTS: A total of 874 patients were followed up for a period of 2 to 63 mo. The overall 1-, 3- and 5-year survival rates were 67.8%, 28.7% and 18.8% respectively. The 1- 3- and 5- year survival rates of patients who received TACE were 74.7%, 41.4%, 36.9% before hepatectomy and 78.9%, 40.4%, 37.5% after hepatectomy. The effective rate (PR NC) after TACE and RFA was 93.4%, the 1- and 3- year survival rates were 74.5% and 36.8% after TACE and RFA. The effective rate of PR NC after TACE was 83.2%. The 1-, 3- and 5- year survival rates were 69.3%, 21.7%, 8.4% after TACE. The effective rate of PR NC after TAI was 27.5%, the 1- and 2- year survival rates were 11.6% and 0% after TAI. The liver function, color-ultrosonography finding and alpha-fetoprotein after TACE RFA, TACE and TAI were compared. There was no significant difference in each index between TACE and RFA or TACE as well as in liver function between TACE and RFA or between TACE and TAI. CONCLUSION: The therapeutic effectiveness of TACE before or after hepatectomy is most significant, while the effect of TACE and RFA is better than that of TACE, and the effect of TAI is minimal.     

Radiation therapy has been shown to be adaptable for various stages of hepatocellular carcinoma

In addition to surgical procedures, radiofrequency ablation is commonly used for the treatment of hepatocellular carcinomas(HCCs) of limited size and number. Transcatheter arterial chemoembolization(TACE), using iodized poppy seed oil, Lipiodol and anticancer drugs, has been actively performed for the treatment of unresectable HCC, particularly in Asian countries. Recently, Sorafenib become available for advanced HCCs when the liver is still sufficiently functional. Sorafenib is an oral multikinase inhibitor with antiproliferative and antiangiogenic effects. However, the effect of sorafenib seems to be inadequate to control the progression of HCC. Radiation therapy(RT)for HCC has a potential role across all stages of HCC. However, RT is generally not considered an option in HCC consensus documents or national guidelines, primarily because of insufficient supporting evidence. However, the method of RT has much improved because of advances in technology. Moreover, combined treatment of RT plus other treatments(TACE, sorafenib and chemotherapy etc.) has become one of the alternative therapies for HCC. Therefore, we should understand the various kinds of RT available for HCC. In this review, we focus on various kinds of external beam radiation therapy.     

原发性肝癌综合介入治疗进展

<正>原发性肝癌是全球最常见的恶性肿瘤之一,为全球第5位常见肿瘤,占癌症相关死亡的第三位[1],而其中就有55%肝癌患者发生在我国。手术切除仍然是早期肝癌的主要根治性治疗方法,但由于肝癌早期症状不典型,恶性程度高,易发生转移等原因,临床发现时多数已发展为中晚期肿瘤,可以根治性切除的患者不足20%[2],而以肝动脉栓塞化疗(Transarterial chemoembolization,TACE)为基础的综合介入治疗作     

经肝动脉化疗栓塞联合射频消融术和艾迪治疗原发性肝癌患者疗效及其对外周血T淋巴细胞亚群的影响*

目的 探讨采用肝动脉化疗栓塞术（TACE） 联合射频消融（RFA）和艾迪注射液治疗原发性肝癌（PLC）患者的疗效及其对外周血淋巴细胞亚群和炎性因子水平的影响。 方法 2013年1月~2015年1月收治的76例PLC患者,其中36例接受TACE联合RFA和艾康治疗（观察组）,另40例接受TACE和RFA治疗（对照组）。采用酶联免疫吸附法测定血清C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）和白介素-6（IL-6）水平,使用流式细胞仪测定外周血T细胞亚群。采用Karnofsky评分评估生存质量改善情况。 结果 在治疗后3 m末,观察组疾病缓解率为69.4%,与对照组的55.0%比,差异无统计学意义（P>0.05）,但观察组疾病控制率为91.7%,显著高于对照组的72.5%（P<0.05）;观察组血清CRP、TNF-α和IL-6水平分别为（109.8±13.2） mg/L、（0.5±0.2） pg/mL和（13.4±2.2） pg/mL,均显著低于对照组[（156.2±20.4） mg/L、（1.1±0.2） pg/mL和（24.1±4.4）pg/mL,P<0.05];外周血CD3+和CD4+细胞百分比及CD4+/CD8+比值分别为（60.1±9.7）%、（44.3±8.3）%和（1.9±0.5）,均显著高于对照组[（52.2±9.9）%、（36.30±8.6）%和（1.4±0.3）,P<0.05];观察组生存质量改善率为80.5%,显著高于对照组的57.5%（P<0.05）;随访24 m,观察组生存28例（77.8%）,对照组生存29例（72.5%）,差异无统计学意义（P>0.05）。 结论 采用TACE联合RFA和艾迪注射液治疗PLC患者近期可调节免疫功能,改善患者生活质量,有一定的临床应用价值。     

经导管动脉化疗栓塞后联合CT引导射频消融肝癌的初步应用

目的 探讨经导管动脉化疗栓塞(TALE)后联合CT引导射频消融(RFA)治疗肝癌的治疗效果并探讨相关介入技术.方法 14例肝癌患者共21个病灶,Child-Pugh分级A级或B级,分别TACE联合CT引导下(RFA)治疗,治疗术前术后均行CT、MRI等影像学检查,并定期随访21个月.结果 14例患者21个病灶的联...     

单纯肝动脉栓塞化疗或联合无水酒精注射治疗肝细胞癌疗效比较的Meta分析

目的评价肝动脉栓塞化疗（TACE）联合无水乙醇注射治疗肝细胞癌的疗效和安全性。方法检索PubMed、Cochrane图书馆、Embase、中国生物医学数据库和万方数据库至2012年12月的最新数据,收集所有TACE联合无水乙醇注射与单纯TACE治疗肝细胞癌患者的随机对照研究（RCT）。按照纳入和排除标准选择文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.1进行Meta分析。结果在13个RCT共962例患者,显示TACE联合无水乙醇注射治疗1年、2年和3年生存率均较单纯TACE更优,其OR值分别为3.78（95%CI为2.79-5.12）、3.07（95%CI为2.27-4.17）和5.84（95%CI为2.86-11.93）;在其中6个RCT共294例患者,联合治疗患者血清甲胎蛋白下降至正常者显著优于单纯TACE治疗组（OR=4.0,95%CI为2.24-7.15）,但两组间AFP下降（≥25%）而未达正常者无明显差异（OR=1.24,95%CI为0.68-2.27）;两组均未出现严重的不良反应。结论 TACE联合无水乙醇注射治疗患者生存率及AFP下降至正常均优于单纯TACE治疗,患者的生存率明显提高,无严重的不良反应。     

Changes in hepatic functional reserve after percutaneous tumor ablation for hepatocellular carcinoma: long-term follow up for 227 consecutive patients with a single lesion

Background/Aims  Percutaneous tumor ablation (PTA), such as ethanol injection, is currently accepted as a potentially curative treatment for hepatocellular carcinoma (HCC). Percutaneous tumor ablation is presumed to be relatively non-invasive, but there are few studies on long-term follow-up of liver function after tumor ablation. Methods  Changes in liver functions were monitored in 227 consecutive patients treated for a solitary HCC nodule by PTA between 1993 and 1997. The liver function evaluated based on Child-Turcotte classification prior to the initial treatment was Child A in 119 (52.4%) patients, B in 81(35.7%), and C in 27 (11.9%). The follow-up period was 46 ± 21 months. Results  The five-year survival rates of patients in Child A, B, and C group after treatment were respectively 76%, 45%, and 43%. Annual shift rate of Child A to Child B was 7%, and that of Child B to Child C was 14%. Tumor recurrence significantly affected aggravation of liver function in Child A (P = 0.002) but not in Child B patients (P = 0.55). Tumor size at initial treatment influenced changes of liver function in Child B group patients (P = 0.009). Conclusions  Preservation of liver function may be essential when treating HCC patients with impaired liver function.     

Combining radiofrequency ablation and ethanol injection may achieve comparable long-term outcomes in larger hepatocellular carcinoma (3.1–4 cm) and in high-risk locations

Radiofrequency ablation (RFA) is more effective for hepatocellular carcinoma (HCC) < 3 cm. Combining percutaneous ethanol injection and RFA for HCC can increase ablation; however, the long-term outcome remains unknown. The aim of this study was to compare long-term outcomes between patients with HCC of 2–3 cm versus 3.1–4 cm and in high-risk versus non-high-risk locations after combination therapy. The primary endpoint was overall survival and the secondary endpoint was local tumor progression (LTP). Fifty-four consecutive patients with 72 tumors were enrolled. Twenty-two (30.6%) tumors and 60 (83.3%) tumors were of 3.1–4 cm and in high-risk locations, respectively. Primary technique effectiveness was comparable between HCC of 2–3 cm versus 3.1–4 cm (98% vs. 95.5%, p = 0.521), and HCC in non-high risk and high-risk locations (100% vs. 96.7%, p = 1.000). The cumulative survival rates at 1 year, 3 years, and 5 years were 90.3%, 78.9%, and 60.3%, respectively, in patients with HCC of 2–3 cm; 95.0%, 84.4%, and 69.3% in HCC of 3.1–4.0 cm (p = 0.397); 90.0%, 71.1%, and 71.1% in patients with HCC in non-high-risk locations; and 92.7%, 81.6%, and 65.4% in high-risk locations (p = 0.979). The cumulative LTP rates at 1 year, 3 years, and 5 years were 10.2%, 32.6%, and 32.6%, respectively, in all HCCs; 12.6%, 33.9%, and 33.9% in HCC of 2–3 cm; 4.8%, 29.5%, and 29.5% in HCC of 3.1–4 cm (p = 0.616); 16.7%, 50.0%, and 50.0% in patients with HCC in non-high-risk locations; and 8.8%, 29.9%, and 29.9% in patients with HCC in high-risk locations (p = 0.283). The cumulative survival and LTP rates were not significantly different among the various subgroups. Combining RFA and percutaneous ethanol injection achieved comparable long-term outcomes in HCCs of 2–3 cm versus 3.1–4.0 cm and in high-risk versus non-high-risk locations. A randomized controlled or cohort studies with larger sample size are warranted.     

射频消融联合TACE治疗原发性肝癌患者疗效及对外周血T细胞亚群的影响

目的 探讨射频消融联合TACE治疗原发性肝癌患者的疗效及其对外周血T细胞亚群的影响。方法 2014年1月~2016年2月间于我院接受TACE治疗的原发性肝癌患者97例,按照TACE术后是否接受射频消融治疗,将患者分为联合组52例和TACE组45例。采用ELISA法检测血清细胞因子。对两组患者的治疗效果、治疗前后T细胞亚群变化情况以及治疗后生存质量进行比较。结果 联合组总有效率为67.31%,显著高于TACE组的40.00% （P<0.05）;联合组疾病控制率为90.38%,显著高于TACE组的73.33%（P<0.05）;联合组治疗后3个月外周血CD3⁺T细胞、CD4⁺T细胞、CD4⁺/CD8⁺比值分别为（68.40±10.20）%、（45.76±6.83）%和（1.96±0.31）,均明显高于TACE组【（56.14±6.75）%、（33.27±5.16）%和（1.21±0.22）,P<0.05】,联合组CD8⁺T细胞百分比为（22.08±2.55）%,显著低于TACE组【（28.42±3.97）%,P<0.05】;联合组患者治疗后3个月外周血IL-6、IL-8和TNF-α水平分别为（129.45±67.14） pg/mL、（0.49±0.13） ng/mL和（134.78±88.20） pg/mL,均明显低于TACE组【（165.30±65.91）pg/mL、（0.72±0.20） ng/mL和（200.43±84.02）pg/mL,P<0.05】;联合组患者生活质量改善率为55.77%,显著高于TACE组的40.00%（P<0.05）,联合组患者并发症发生率为73.08%,与TACE组的71.11%相比无统计学差异（P>0.05）。结论 射频消融联合TACE治疗原发性肝癌患者近期疗效较好,可改善患者免疫功能,提高生存质量。     

Short-term interval combined chemoembolization and radiofrequency ablation for hepatocellular carcinoma

AIM: To investigate hepatic function after combined transcatheter arterial chemoembolization (TACE) and radiofrequency ablation (RFA) with a short-term interval (0-2 d).METHODS: A total of 115 patients with compensated liver cirrhosis underwent RFA combined with TACE at a time-interval of 0-2 d for the treatment of hepatocellular carcinoma (HCC) < 5.0 cm. There were 21 patients who received further hepatic directed treatment altering liver function within 12 mo after the combined therapy for HCC-recurrence, and were excluded. The remaining 94 patients who survived without HCC-recurrence were included in this retrospective study.RESULTS: At 1 mo after treatment, Child-Pugh scores (CPs) remained unchanged in 89 of 94 patients (94.7%), and transiently increased by one-point in 5 patients (5.3%). However, the score returned to baseline score at 3 mo and was maintained until 6 mo in all patients. The baseline CPs of 8 or more was identified as a factor for transient rise of CPs after the treatment (CPs 8/9 vs 5/6/7; 21.4% vs 2.5%; P = 0.022). At 12 mo follow-up, CPs was unchanged in 90 patients (95.7%), and increased by one-point in 4 patients (4.3%). The rise of CPs at 12 mo was not statistically associated with the initial transient rise of CPs. There were procedure-related complications in 3 patients (3.2%), but the complications were resolved by medical and interventional treatments without hepatic functional sequelae.CONCLUSION: The combined TACE and RFA with an interval of 0-2 d are safe for the management of HCC < 5 cm in cirrhotic patients.     

伴失代偿肝硬化的肝癌患者综合介入治疗

目的 探讨伴失代偿性肝硬化的原发性肝细胞癌(HCC)患者综合介入治疗临床价值.方法 42例伴肝功能失代偿HCC患者在内科治疗稳定后接受肝动脉节段性化学栓塞治疗(S-TACE),并在1～2周内序贯射频消融(RFA)和无水乙醇局部注射(PEI)治疗.结果 随访3～48月,甲胎蛋白(AFP)于术后2～4周开始下降,27例(70.00%)逐渐达到正常;3个月后肿瘤缩小50%以上者占54.76%(23/42);中位生存期14.1月,6个月、12个月和24个月累计生存率分别为78.57%(33/42)、40.48%(17/42)和19.05%(8/42);单变量分析显示,包括HBV DNA在内的14项因素与预后显著相关,多因素Cox模型分析显示,ICGR15、门静脉癌栓、治疗次数和AFP术前升高者介入后变化与预后显著相关.结论 综合介入治疗是伴失代偿性肝硬化HCC的有效治疗方法,对HBV DNA阳性HCC患者介入前应考虑抗病毒治疗.     

Loco-regional treatment of hepatocellular carcinoma: Role of contrast-enhanced ultrasonography

Hepatocellular carcinoma (HCC) is one of the few cancers for which locoregional treatments (LRTs) are included in international guidelines and are considered as a valid alternative to conventional surgery. According to Barcelona Clinic Liver Cancer classification, percutaneous treatments such as percutaneous ethanol injection, radiofrequency ablation and microwave ablation are the therapy of choice among curative treatments in patients categorized as very early and early stage, while transcatheter arterial chemoembolization is considered the better option for intermediate stage HCC. A precise assessment of treatment efficacy and surveillance is essential to optimize survival rate, whereas residual tumor requires additional treatment. Imaging modalities play a key role in this task. Currently, contrast-enhanced computed tomography/magnetic resonance imaging are considered the standard imaging modalities for this purpose. Contrast enhanced ultrasound (CEUS), using second generation contrast agents, plays an increasingly important role in detecting residual disease after LRTs. CEUS is a straightforward to perform, repeatable and cost-effective imaging modality for patients with renal failure or iodine allergies. Due to the ability to focus on single regions, CEUS can also provide high temporal resolution. Moreover, several studies have reported the same or better diagnostic accuracy as contrast-enhanced computed tomography for assessing tumor vascularity 1 mo after LRTs, and recently three-dimensional (3D)-CEUS has been reported as a promising technique to improve the evaluation of tumor response to therapy. Furthermore, CEUS could be used early after procedures in monitoring HCC treatments, but nowadays this indication is still debated, and data from literature are conflicting, especially after transcatheter arterial chemoembolization procedure.     

超声引导射频消融联合无水酒精注射治疗特殊部位肝癌的效果观察

目的探讨超声引导射频消融(RFA)联合无水酒精注射(PEI)治疗特殊部位肝癌的方法与疗效。方法对进行了超声引导射频消融联合无水酒精注射治疗的41例特殊部位肝癌患者的49个瘤体的临床数据进行回顾性总结分析。49个瘤体的治疗方法:43个经皮超声引导PEI+RFA,3个腔镜超声引导PEI+RFA,3个开腹超声引导PEI+RFA。PEI+RFA的方法:超声引导实时监控下对肿瘤的RFA高危侧,即特殊部位侧进行至少5 mm以上的完整覆盖的PEI,然后对肿瘤行RFA治疗,RFA治疗的布针保持在特殊部位肿瘤内距离比邻器官或管道的5 mm处。疗效评价:术后一月进行肝脏超声造影或增强CT扫描评价术后消融率。结果经皮PEI+RFA的43个瘤体的完全消融率为93.02%(40/43),腔镜及开腹PEI+RFA 6个瘤体的完全消融率均为100%(6/6),全部患者均无邻近器官损伤及腹腔大出血等严重并发症,部分患者有轻度的术后疼痛、低烧等轻微不良反应,无需特殊处理。全部患者治疗后7 d康复出院。结论超声引导PEI+RFA可很好地解决特殊部位肝癌消融治疗的彻底性和安全性,是特殊部位肝癌的效果确切、安全可行的治疗方法。开腹和腹腔镜下消融可提高消融的彻底性。     

Review of dynamic contrast-enhanced ultrasound guidance in ablation therapy for hepatocellular carcinoma

Local ablative techniques-percutaneous ethanol injection, microwave coagulation therapy and radiofrequency ablation (RFA)-have been developed to treat unresectable hepatocellular carcinoma (HCC). The success rate of percutaneous ablation therapy for HCC depends on correct targeting of the tumor via an imaging technique. However, probe insertion often is not completely accurate for small HCC nodules, which are poorly def ined on conventional B-mode ultrasound (US) alone. Thus, multiple sessions of ablation t...     

Combined therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation for small hepatocellular carcinoma

AIM： To assess the efficacy of combined transcatheter arterial chemoembolization （TACE） and percutaneous microwave coagulation therapy （PMCT） for small hepatocellular carcinoma （HCC）.
METHODS： Thirty-five patients with a total of 41 HCC nodules （≤ 3 cm in diameter） were treated with TACE followed by computed tomograghy （CT）-guided percutaneous microwave coagulation therapy （PMCT） within 1-3 wk.
RESULTS： By biopsies and enhanced CT scans, complete necrosis of the tumor and 3-5 mm of the surrounding non-cancerous area were observed in 34 foci. In seven foci, incomplete necrosis of the surrounding parenchyma was observed. Serum alphafetoprotein （AFP） levels returned to normal 10 d after treatment in 25 patients who originally had high serum AFP levels. The follow-up period was 6-31 mo, and all patients remained alive. One patient had a recurrence in the subsegments of the liver, and another patient had a recurrence near the original lesion.
CONCLUSION： Combined therapy with TACE and PMCT is a safe and effective treatment without severe complications for small HCC.