超声引导下经皮微波消融治疗肝细胞性肝癌术后复发灶远期疗效评估

目的评价肝细胞性肝癌(hepatic cellular carcinoma,HCC)手术后复发灶(直径≤5 cm)超声引导下经皮微波消融(microwave ablation,MWA)治疗的远期疗效及其影响因素。方法 2005年5月~2011年12月,89例HCC复发患者行经皮微波消融治疗。所有HCC复发患者在MWA治疗后1个月均行超声造影、增强CT或者增强磁共振检查;以及血生化检查,包括血清甲胎蛋白(AFP)、肝功能等。结果消融治疗1个月后,病灶完全消融率91%(81/89)。HCC经皮MWA治疗后,1、3、5、7年生存率分别为73.3%、53.7%、39.6%、17.3%。肿瘤大小(P=0.046)、肿瘤数目(P=0.001)、Child-Pugh分级(P=O.023)、AFP水平(P=0.003)以及HCC早期复发(≤1年)(P=0.013)为总体生存率的单因素回归分析的危险预后因素。肿瘤数目(P=0.000)、Child-Pugh分级(P=0.000)和AFP水平(P=0.001)是HCC经皮MWA治疗后总体生存率重要的独立危险因素。结论经皮MWA对于肝细胞性肝癌切除术后复发灶是有效、安全的治疗方法 。

Long-term outcome of percutaneous microwave ablation of recurrent hepatocellular carcinoma after hepatectomy

ObjectiveThe purpose of this study was to evaluate the long-term outcome of percutaneous microwave ablation（MWA） of recurrent hepatocellular carcinoma（HCC）measuring ≤ 5cm after hepatectom.Methods From May 2005 to December 2011, 89 patients with 116 recurrent HCCs after hepatectomy were treated by percutaneous MWA.Results One month after MWA, the complete ablation rate was 91.0%（81/89）with overall survival rates of 73.3%, 53.7%, 39.6% and 17.3% at 1, 3, 5 and 7 years, respectively. Multivariate analysis showed that multiple tumors（P=0）, poor Child-Pugh score（P=0）, and serum alpha fetoprotein level 〉100 ng/ml（P=0.001）were significant risk factors affecting overall survival. Multiple tumors（P=0.008）and poor Child-Pugh score（P=0.012）were significant risk factors affecting recurrence-free survival.Conclusion Percutaneous MWA is effective for treating recurrent HCC measuring ≤ 5cm after hepatectomy.