B超引导下微波消融术在老年患者高危部位肝癌中的应用

目的 探讨B超引导下经皮肝穿刺微波消融治疗老年患者高危部位肝癌（指邻近胆囊、肝门部管道、下腔静脉以及位于脏面贴近腹内脏器的肝癌，且肿瘤距上述脏器或管腔最短距离≤1 cm）中的疗效和应用价值。方法 回顾分析2007年3月至2012年6月间我科收住的24例老年肝癌患者31个高危部位肝癌进行微波消融治疗的临床资料。术后观察肿瘤大小、AFP变化、肝功能及其他相关并发症。结果 PMCT治疗1个月后全组肿瘤直径及AFP值较前明显下降，治疗前肿瘤直径（4.25±1.02）cm，治疗后（2.82±0.63）cm（P＜0.05），治疗前整体AFP值（457.3±27.4）μg/L，治疗后（176.7±17.8）μg/L（P＜0.01），22例患者术后有不同程度的肝功能异常，对症治疗后好转。术后14例出现轻至中度发热，17例出现伤口或肝区疼痛，2～10 d后缓解。结论 B超引导下微波消融术在治疗老年患者高危部位的肝癌中疗效明显，定位精确，副作用小，对于无法切除肝癌的老年患者是一种积极有效的治疗手段，同时可避免手术的相关并发症。

The application of B ultrasound-guided percutaneous microwave coagulation therapy for hepatocel- lular carcinoma abutting high risk locations in elderly patients

To evaluate the efficacy of B ultrasound-gided percutaneous microwave coagulation therapy （PMCT） for hepatocellular carcinoma abutting gallbladder, hilar bile duct, inferior vena cava, and hepatic subcapsular mass near the intra-abdominal organ of high risk （the shortest distance of tumor from the organ 〈 1.0 cm）. Methods From Mar. 2007 to Jun. 2012, 24 patients of hepatocellular carcinoma with 31 high risk locations were treated by PMCT. The clinical symptoms of pre-and post-operative, such as tumor diameters, AFP levels, hepatic functional changes, and other related complications were observed. Results One month after PMCT, the tumor diameter and AFP level were declined, preoperative tumor diameter was （4.25 ~ 1.02） cm and diminished to （2.82 ＋ 0.63） cm postoperatively （P〈0.05）. Preoperative serum AFP level of all patients was （457.3 ~ 27.4 tag/L） lag/L and decreased obviously to （176.7 ~ 17.8） lag/L postoperatively （P〈0.01）. 22 patients had abnormal liver function, 14 cases suffered fever, 17 cases had pain of which relieved 2 - 10 d later. Conclusion B ultrasound guided PMCT in the treatment of hepatocellular carcinoma abutting dangerous location in elderly patients is an effective method and it would be beneficial to the complications compared with the operation.