射频消融治疗肝内血管旁转移瘤24例

目的:评价CT引导下射频消融治疗肝内血管(直径>3mm)旁转移瘤的疗效及安全性.方法:24例单发肝转移瘤患者行RFA治疗(年龄范围:36-95岁,男女比例18∶6),所有病灶均在肝内直径>3mm的血管旁.肿瘤直径为:1.7-5.1cm.对照组选择同期行RFA的单发肝脏转移瘤患者,且病灶远离血管或者胆囊等,共25例.术后1、3、6、12、24mo分别行影像学检查随访.结果:24例患者共24个病灶接受了治疗.20例患者(83%)获得了完全的肿瘤坏死.4例患者出现了病灶周边不规则的强化,接受了再次治疗.2年随访肿瘤局部控制率为50%.试验组仅1例患者出现肝内小血肿,其余患者均未发生血管相关并发症.结论:即使紧邻肝内大血管的转移瘤,行RFA仍然安全、有效,并发症少,肿瘤进展率低.

Radiofrequency ablation for liver metastases in contact with blood vessels: an analysis of 24 cases

AIM: To evaluate the efficacy and safety of computed tomography (CT)-guided radiofrequency thermal ablation (RFA) for liver metastases that were in contact with blood vessels. METHODS: RFA was performed in 24 patients with liver metastases that were in contact with blood vessels (>3 mm in diameter). Tumor diameter ranged from 1.7 to 5.1 cm. Twentyfive patients with liver metastases that were not in contact with blood vessels or cholecyst also underwent RFA and were used as controls. Imaging follow-up was performed at 1, 3, 6, and 12 months post RFA, and every year thereafter. RESULTS: All of 24 patients were treated for a total of 24 sessions. Complete ablation of the tumor was achieved in 20 (83%) patients, and the remaining 4 (17%) patients showed irregular peripheral enhancement and underwent a second session. At 1-year follow-up, one patient showed a recurrent lesion and a new ablation was performed. The local tumor progression rate at 2-year follow-up was 50%. Complications occurred in only one patient, and he developed a small subcapsular hematoma. CONCLUSION: RFA is safe and effective even in patients with high risk liver metastases adjacent to large blood vessels and can lead to good results with minimal complications and a low rate of tumor progression.