CT引导下经皮微波消融治疗膈顶部复发性小肝癌15例疗效观察

目的:回顾性分析经肝脏CT引导下经皮微波消融（CT-MWA）治疗膈顶区域复发性小肝癌的临床疗效及安全性。方法:对2009年8月至2015年2月共15例位于膈顶部位复发性小肝癌患者的小病灶（<3 cm）进行CT引导下经皮微波消融术治疗的临床资料进行回顾性分析。分析总结微波消融治疗膈顶复发性小肝癌的1、3年生存率、完全消融率、局部进展率、术中及术后并发症、不良反应。结果:本研究15个小病灶进行CT-MWA治疗成功率和完全消融率分别为93.33%(14/15)和86.67%(13/15)。术中疼痛发生率为46.67%(7/15)。术后常见不良反应为肝区疼痛(33.33%)、胃肠道反应(46.67%)、发热(13.33%)、肝功能异常(13.33%)，无肝功能衰竭、胆瘘、感染、出血等严重并发症，无围手术期死亡病例。15例患者平均存活时间为42个月。术后3个月、6个月、1年及1年以上的肿瘤局部进展率分别为6.67%(1/15)、6.67%(1/15)、13.33%(2/15)、13.33%(2/15)。1、2、3年生存率分别为86.67%(13/15)、66.67%(10/15)、46.67%(7/15)。结论:经皮CT-MWA 治疗膈顶区域复发性小肝癌是一种安全有效的微创治疗方法，值得扩大样本量进一步研究。

Clinical observation of CT-guided microwave ablation in 15 cases of recurrent small hepatocellular carcinoma against the diaphragmatic dome

Objective:To retrospectively analyze the clinical efficacy and safety of CT-guided percutaneous microwave ablation (CT-MWA) in the treatment of recurrent small hepatocellular carcinoma (HCC).Methods:A total of 15 patients with recurrent small HCC which against the diaphragmatic dome underwent CT-MWA of clinical data from August 2009 to February 2015 were retrospectively analyzed.To summarize the 1，3-year survival rate，complete ablation rate，local rate of progress，intraoperative and postoperative complications and adverse reactions in the treatment of recurrent small HCC against the diaphragmatic dome.Results:The success rate and complete ablation rate were 93.33% (14/15) and 86.67% (13/15) respectively.The incidence of intraoperative pain was 46.67% (7/15).Postoperative adverse reactions included gastrointestinal reactions (46.67%)，liver pain (33.33%)，fever (13.33%)，abnormal liver function (13.33%).No liver failure，biliary fistula，infection，bleeding and other serious complication，no perioperative death cases.The average survival time was 42 months for 15 patients.The local progression rates of 3 months，6 months，1 year and more than 1 year were 6.67% (1/15)，6.67% (1/15)，13.33% (2/15) and 13.33% (2/15)，respectively.The survival rates of 1 year，2 years and 3 years were 86.67% (13/15)，66.67% (10/15) and 46.67% (7/15)，respectively.Conclusion:For recurrent small HCC against the diaphragmatic dome，percutaneous CT-MWA is a safe and effective minimally invasive treatment and it is worth to further study with more samples.