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目的探讨经皮细刀头氩氦刀靶向冷冻治疗肝癌的有效性及安全性。方法从2006年6月至2007年6月,广东省佛山市第一人民医院在超声引导下采用Cryo-Hit氩氦刀1.47mm细刀头对26例原发性肝癌、15例复发性肝癌和13例转移性肝癌总共105个瘤灶(直径0.8~12.0cm)经皮靶向冷冻治疗。每3~6个月复查血清肿瘤标记物、B超、CT或MR评价瘤灶坏死情况,采用Kaplan-Meier统计分析存活率。结果原发性肝癌组、复发性肝癌组以及转移性肝癌组术后1年累积存活率分别为81.82%、46.22%和80.21%。术后复查B超、CT或MR均提示瘤灶不同程度的缩小甚至消失,对于直径<3cm的肿瘤完全坏死率达96.2%,直径3~5cm的肿瘤完全坏死率达90.6%,直径>5cm的肿瘤完全坏死率达28.6%。无出血、胆漏等严重并发症发生。结论超声引导经皮细刀头氩氦刀靶向冷冻治疗肝癌是继射频、微波之后又一安全、有效的经皮局部消融治疗新方法,其远期疗效还有待长期随访观察。

Ultrasound-guided minimally invasive targeting Argon-Helium cryoablation in the treatment of hepatic carcinoma

??Objective:To explore the effectivity and safety of minimally invasive targeting Argon??Helium cryoablation in the treatment of hepatic carcinoma. Methods:Ultrasound??guided Argon??Helium targeting cryoablation using the Cryo??Hit system with 1.47mm fine probe was performed percutaneously in 26 cases of primary hepatic carcinoma,15 cases of recurrent hepatic carcinoma and 13 cases of metastatic carcinoma with a total of 105 foci between June 2006 and June 2007 in the First People’s Hospital of Foshan.Serum tumor markers were detected and tumor necrosis was evaluated by ultrasonography,CT scan or MRI every 3 to 6 months.Survival rate was analyzed with Kaplan??Meier method. Results:One-year cumulative survival rates of primary,recurrent and metastatic hepatic carcinoma were 81.82%,46.22% and 80.21% respectively.Tumor foci diminished in different degrees or even disappeared when performed ultrasonography,CT scan or MRI after the procedures.Tumor complete necrosis rate could reach 96.2% to the foci less than 3cm,and they were 90.6% to the foci between 3cm to 5cm in size and 28.6% to the foci larger than 5cm.No complications such as bleeding or bile leakage were found. Conclusion:Ultrasound??guided targeting treatment of hepatic carcinoma with Argon??Helium cryoablation using fine??probe Cryo??Hit system is a new,safe and effective procedure coming after radio??frequency and microwave ablation,although its long??term curative effects needs long??term follow-up survey.