不同肝癌治疗中超声引导微波热凝的临床分析

目的 评价经皮微波凝固疗法(PMCT)对肝癌结节(<5.0 cm)的疗效，以及联合经导管肝动脉栓塞化疗(TACE)治疗大肝癌(>5.0 cm)的效果。 方法 在超声引导下对76例肝癌结节患者共135个肿瘤灶行PMCT；48例大肝癌59个肿瘤灶采用PMCT联合TACE治疗。 结果 术后肝癌结节的完全消融率达91.9%，94.1%的瘤体内血流信号消失，其余均减少，无明显肝功能异常。47例AFP阳性患者中24例降至正常，14例明显下降。1、3、5年的生存率分别为92.1%、75.0%、51.3%；累计复发率分别为22.4%、48.7%、69.2%。大肝癌经PMCT联合TACE治疗后，所有瘤内血流均呈消失或减少，71.2%的肿瘤缩小，缩小中位值2.7 cm。42例AFP阳性患者中27例降至正常，6例明显下降。缓解率(CR+PR) 89.6%；1、3、5 年生存率分别为87.5%、56.3%、29.2%。 结论 PMCT治疗<5.0 cm的肝癌结节，可以达到原位灭活作用，效果理想；PMCT联合TACE为不能手术切除的大肝癌(>5.0 cm)提供了有效的治疗方法，对延长患者生存期，改善生存质量有重要意义。

Clinical application of percutaneous microwave coagulation therapy for variant hepatocarcinoma

【Abstract】 Objective To evaluate the outcome of PMCT for hepatocellular carcinoma nodules (<5.0 cm) or combined with TACE for large liver cancer (>5.0 cm). Methods Ultrasound-guided PMCT was performed in 76 patients with 135 carcinoma nodules and combined with TACE in 48 patients with 59 tumors. Results The complete ablation rate in cases with nodules less than 5.0 cm was 91.9% and there were no obvious liver dysfunctions. The flow signal disappeared in 94.1% and decreased in the other cases of this group. Among the 47 AFP positive patients, there were 24 cases returning to normal and 14 cases decreasing significantly. The survival rate in 1, 3, 5 years was 92.1%, 75.0%, 51.3% and the recurrence rate was 22.4%, 48.7%, 69.2% respectively. After treated with PMCT and TACE, the tumor size decreased in 71.2% of the large liver cancer cases with the mean of 2.7 cm and blood flow reduced or disappeared. Among the 42 AFP positive patients, there were 27 cases returning to normal and 6 cases decreasing significantly. CR+PR was 89.6% postoperatively, and the survival rate in 1, 3, 5 years was 87.5%, 56.3%, 29.2% respectively. Conclusion The outcome of PMCT for hepatocellular carcinoma nodules less than 5.0 cm is ideal. Furthermore, PMCT combined with TACE is appropriate for patients with inoperable large liver tumors to extend life span and increase life quality.