冷循环微波刀后肝动脉化疗栓塞术治疗原发性肝细胞癌

目的探讨原发性肝细胞癌冷循环微波刀后肝动脉化疗栓塞术的疗效及必要性。方法对165例原发性肝细胞癌患者冷循环微波刀后进行1次以上的TACE治疗。其中男154例,女11例,年龄在19～73岁,平均46岁。肿瘤长径≤3cm者84例,3.1～5.0cm者37例,〉5.0cm者44例。按肝功能Child-pugh分级,A级151例,B级14例。均经病理诊断为肝细胞癌。采用ECO2100冷循环微波刀（南京亿高微波系统工程有限司产品）治疗行冷循环微波刀,并随后常规行CT以评价冷循环微波刀的疗效,然后行TACE,术后1月行CT检查,以评价肿瘤消融情况,并观察生存率,以评价治疗效果。结果冷循环微波刀后完全缓解84例,基本缓解56例,部分缓解25例。冷循环微波刀＋TACE的近期效果为根治性122例、亚根治性13例和姑息性30例。肿瘤消融程度与近期疗效密切相关r=0.877,P〈0.001。肝癌冷循环微波刀＋TACE治疗后总体1,2,3年生存率为78.2%,65.3%,44.0%。结论 TACE对冷循环微波刀后残余的癌灶或微小转移病灶可起治疗作用;尤其对于大肝癌冷循环微波刀后联合TACE是安全有效及必要的。

TACE after psychro-circulation percutaneous microwave coagulation therapy(PMCT) for hepatocellular carcinoma

Objective To evaluate the effi cacy and the necessity of psychro-circulation percutaneous microwave coagulation therapy（PMCT） followed by transarterial chemoembolization（TACE） for patients with unresectable hepatocellular carcinoma. Methods From January 2007 to December 2008,165 patients with unresectable hepatocellular carcinoma underwent TACE after PMCT. One hundred and fi fty-four cases were male,and 11 female. The maximum diameter of the tumor was 1.5cm to 10 cm,in which 84 were small（maximum diameter≤3cm） ,17 were medium（3. 1–5.0cm） and 34 were large（5cm） . The liver function（in Child-Pugh classifi cation） was class A in 151 cases,and class B in 14 cases. All cases were hepatocellular carcinoma. PMCT was performed by a PMCT expandable electrodes device and followed by TACE. PMCT response was evaluated with computed tomography performed one month after PMCT,and then treatment efficacy was evaluated by observation of survival. Results Classifi ed by PMCT response,complete ablation was achieved in 84 cases,nearly ablation in 56 cases and partial ablation in 25 cases. The treatment effi cacy of PMCT plus TACE was curative in 122 cases,sub-curative in 13 cases and palliative in 30 cases. The total survival rate after PMCT plus TACE at 1,2 and 3 years was 78. 2%,65. 3% and 44. 0%,respectively. Conclusions TACE following PMCT has therapentic effect and is nccessary for patients with medium or large hepatocellular carcinoma to eradicateresidual tumor and micr-metastasis.