CT导向下高频介入热治疗在肝内胆管癌治疗中的价值

目的 探讨高频介入热治疗(high frequency induced thermotherapy,HiTF)在肝内胆管癌治疗中的价值.方法 本组17例肝内胆管癌患者,均为2006年1月至2007年9月期间中山大学附属肿瘤医院介入病区住院患者,共21个病灶,采用以HiTT为核心手段的综合治疗措施进行治疗,对于存在梗阻性黄疸的患者(12/17)先行经皮穿刺肝胆管内外引流术(percutaneous trans-hepatic choloangic drainage,PTCD)或胆道支架植入术,待肝功能改善后,再行HiTT治疗,治疗后1～2周,根据患者恢复状况,采用吉西他滨+草酸铂方案化疗4～6个疗程.结果 HiTT治疗1周行CT复查,近期治疗成功率达100%(17/17),病灶单针原位消融灭活率76%(16/21).近期随访的平均生存期为13.5个月.患者主要不良反应包括局部出血,术后疼痛,肝功能损害及发热等,经积极对症支持治疗均恢复正常.结论 HiTT射频消融在肝内胆管癌的治疗中有较高的临床应用价值.

Clinical value of CT-guided high frequency-induced thermotherapy its a treatment for intrahepatic cholangiocarcinoma

Objective To evaluate the therapeutic effect of CT-guided high frequency-induced thermotherapy (HiTT) for intrahepatic cholangiocarcinoma. Methods Seventeen patients of intrahepatic cholangiocarcinoma with 21 lesions underwent comprehensive treatment with HiTT as the principle approach.As to the patients with obstructive jaundice, percutaneous trans-hepatic cholangial drainage (PTCD) or bile duct endoprosthesis placement was performed first to improve the liver function, then HiTT was performed;and patients without obstructive jaundice underwent CT-guided HiTT directly, 1-2 weeks later,chemotherapy was given for 4 -6 courses. Results CT scan 1 week after HiTT showed a short-term achievement rate of 100% ( 17/17), and the single puncture in situ ablation rate was 76.1%( 16/21 ). The average life span in the near future was 13.5 months. The adverse effects included topo-bleeding, pain after procedure, liver function damage, fervescence, etc. All the patients recovered after symptomatic treatment.Conclusion The clinical value of CT-guided HiTT for intrahepatic cholangiocarcinoma is obvious.