微波消融治疗肝脏恶性肿瘤的临床价值

  目的  探讨微波消融(MWA)治疗肝脏恶性肿瘤的临床疗效及并发症分析。  方法  208例肝脏恶性肿瘤患者接受了241例次的MWA。肝细胞肝癌(HCC)171例行198例次的MWA, 肿瘤总数301个, 平均1.5个, 肿瘤平均最大直径(2.9±1.3)em, 其中57例接受了肝切除联合MWA; 肝转移癌(MLC)37例行43例次的MWA, 肿瘤总数67个, 平均1.6个, 肿瘤平均最大直径(2.6±1.5)cm。全组病例的治疗通过经皮和开腹两种途径, 治疗后定期进行影像学和肿瘤标志物检查。  结果  MWA 1个月后行增强CT检查, HCC 301个肿瘤中285个完全消融, 完全消融率为94.7%(285/301), MLC 67个肿瘤中62个完全消融, 完全消融率为92.5%(62/67)。随访3~43个月, HCC局部复发率为8.4%(24/285), 1、2、3年生存率分别为89.0%、74.2%、53.6%, 其中肝切除联合MWA治疗的患者1、2、3年生存率分别为81.3%、66.4%、46.7%;MLC局部复发率为9.7%(6/62), 中位生存期17~23个月。HCC患者MWA的严重并发症发生率为2.5%(5/198), MLC患者的治疗未出现严重并发症。  结论  MWA治疗肝脏恶性肿瘤创伤小, 安全有效, 具有重要的临床价值。 

Clinical Value of Microwave Ablation in Treating Malignant Liver Tumors

  Objective  This study aims to explore the treatment effect and relevant complications of microwave ablation (MWA) therapy on malignant liver tumors.  Methods  MWA was conducted in 208 liver tumor patients (241 surgical procedures). Among the total number of cases, MWA was conducted in 171 hepatocellular carcinoma (HCC) patients suffering from 301 tumors (average, 1.5 tumors; 198 procedures). The largest tumor diameter was 2.9 ~ 1.3 cm. Among the 171 HCC patients, 57 were subjected to MWA combined with hepatectomy. MWA was conducted in 37 metastatic liver cancer (MLC) cases suffering from 67 tumors (average, 1.6 tumors; 43 procedures). The largest tumor diameter was 2.6±1.5 cm. All patients were treated with MWA via percutaneous or open surgery.  Results  Contrast-enhanced computed tomography was performed 1 month after MWA. The complete ablation rate for HCC and MLC was 94.7% (285/301) and 92.5% (62/67), respectively. The patients were followed-up for 3 months to 43 months. The local recurrence rate of tumors was 8.4% (24/285), and the one-, two-, and three-year survival rates were 89.0%, 74.2%, and 53.6%, respectively. The one-, two-, and three-year survival rates of the patients who underwent MWA plus hepatectomy were 81.3%, 66.4%, and 46.7%, respectively. The local recurrence rate of tumors was 9.7% (6/67), and the median survival time for the MLC patients ranged between 17 and 23 months. The rate of severe complications for the HCC patients undergoing MWA was 2.5% (5/198). Severe complications did not occur in the MLC patients.  Conclusion  Treating malignant liver tumors through MWA is safe, effective, and less invasive. The clinical value is significant.