大肝癌的消融治疗

肝癌是我国最常见的恶性肿瘤之一,当单个肿瘤直径大于5 cm时定义为大肝癌。大肝癌具有肿瘤恶性程度高、易出现肿瘤转移和血管浸润等特点,增加了治疗的难度。外科切除是大肝癌首选的治疗方案,但仅有20%~30%的患者符合手术治疗要求。对于不可切除的大肝癌国内外指南推荐经肝动脉化疗栓塞术(TACE)作为治疗方案,TACE可以控制肿瘤进展并延长患者生存时间,但反复多次的TACE治疗疗效有限,且对患者肝功能造成严重损害,单独的TACE治疗已无法满足临床需求。随着肿瘤消融技术如射频、微波和冷冻消融等不断发展,TACE联合肿瘤消融治疗已成为大肝癌治疗中的一个重要治疗手段。然而目前国内外关于大肝癌消融治疗的疗效仍有较多的争议,因此如何选择合适的消融时机,减少消融术后残留,降低消融术后肿瘤的复发,最终使患者生存获益是目前临床和科研仍需继续探讨的难题。针对以上内容,综述并分析了大肝癌消融治疗的现况、困境及未来发展趋势。

Ablation therapy for large hepatocellular carcinoma

Hepatocellular carcinoma(HCC)is one of the most common malignant tumors in China,and when a single tumor is larger than 5 cm in diameter,it is defined as large HCC.Large HCC has the characteristics of high degree of tumor malignancy and high risk of tumor metastasis and vascular invasion,which increases the difficulty of treatment.Surgical resection is the preferred treatment regimen for large HCC,but only 20%-30%of patients are candidates for surgical treatment.Transarterial chemoembolization(TACE)is recommended as the treatment regimen for unresectable large HCC in Chinese and international guidelines.It can control tumor progression and prolong the survival time of patients;however,repeated TACE has limited efficacy and may cause serious damage to liver function,and TACE alone can no longer meet clinical needs.With the development of tumor ablation techniques such as radiofrequency ablation,microwave ablation,and cryoablation,TACE combined with tumor ablation has become an important treatment method for large HCC.However,there are still controversies over the effect of ablation on large HCC,and therefore,how to choose the appropriate ablation time,reduce tumor residue and recurrence after ablation,and finally bring survival benefits to patients remains a difficult problem to be solved in clinical and scientific research.This article reviews the current status,predicaments,and future development trends of ablation therapy for large HCC.