不可切除肝癌的射频治疗

目的探讨射频治疗在不可切除肝癌的治疗效果。方法2006年5月至2008年11月引进Cool—tip冷循环超能射频治疗仪对不可切除肝癌（原发和转移）43例78个病灶在B超引导下施行了射频消融治疗。其中开腹单纯射频治疗15例，开腹肝癌切除＋射频6例，开腹射频＋乙醇注射5例，经皮射频治疗17例。均按需一次单针多点顺次穿刺布针方法完成，最多布针5针，平均2．1针；单灶最大径7cm，平均2．5cm；单例最多病灶6个，平均1．8个。结果所有患者均经CT和B超或MRI诊断，其中原发性肝癌18例，原发性肝癌切除术后复发12例，转移癌13例；43例全部得到随访，术后定期甲胎蛋白、B超和（或）CT检查，最长随访时间28个月，最短1个月，平均13．6个月。术前AFP增高20例，术后3个月内全部恢复正常；2例CT发现可疑针道和周缘残留，6例随访过程出现肝脏新的转移灶；1例经皮射频消融治疗后出现胃肠道瘘入皮下，并于3月后死于多发转移；1例死于开腹射频消融治疗后持续腹腔出血，1例死于开腹肝切除＋射频消融治疗后腹腔出血和感染，3例于随访过程中死于多发转移（该3例平均生存时间6个月）。结论B超引导的冷循环射频消融治疗操作简便、易于掌握，患者痛苦小、恢复快，是一种有效安全的肝癌局部治疗方法。可以作为切除手术的重要辅助手段推广应用。

Radiofrequency ablation in treating unresectable liver cancer.

Objective To investigate the effect of radiofrequency ablation（RFA） in treating unresectable liver cancer. Methods 43 patients（78 lesions） who suffered from unresectable liver cancer were treated with cooltip RFA from May 2006 to November,2008 in our hospital. 26 cases were treated with RFA in laparotomy besides with resect of lesion in 6 cases and with alinjection in 5 cases, while 17 cases were treated only with percutaneous RFA. Results All patients were diagnosed by CT and B-ultrasound or MRI,among whom 18 cases were confirmed with primary hepatic carcinoma,12 cases experienced recurrence following resect of primary hepatic carcinoma and 13 cases developed metastatic carcinoma;Every patient was followed up with AFP, abdominal B-ultrasound, CT scans or MRI from 1 to 28 months after treatment （mean 13.6 months）. Before procedure,AFP increased in 20 cases which recovered within 3 months of treatment. 2 cases were suspected having residual on CT scan,6 cases were found with new masses on liver on CT scan, 1 case complicated with gastrointestinal fistula and then died of systemic metastasis 3 months later, 1 case died of postoperative bleeding and 1 died of bleeding and infection after resect ＋ RFA treatment,and 3 cases died of multi-metastasis during following up who survived on average of 6 months. Conclusions B-ultrasound -guided cool-tip circulation RFA is an effective and safe method in treating unresectable liver cancer.