超声引导经皮微波凝固治疗在肝转移癌中的应用价值

目的　探讨超声引导经皮微波治疗肝转移癌的疗效和影响生存率的因素。方法　共治疗 74例患者 14 9个结节 ,肿瘤最大直径 0 .7～ 6 .8cm ,平均 (3.1± 1.8)cm。累计生存率采用Kaplan Meier方法 ,对生存率影响的单因素分析采用Logrank方法 ,多因素分析采用Cox逐步回归方法。随访患者 5～ 83个月 ,平均随访期 (2 5 .1± 11.4 )个月。结果　全部患者的 1,3,5年生存率分别为 91.4 %、4 6 .4 %和 2 9.0 %。单因素分析结果表明 ,肿瘤的数目、大小、分化程度和病灶有无复发或转移对生存率的影响差异有显著性 ;而患者的年龄、性别和原发灶的部位对生存率的影响差异无显著性。多因素分析结果表明 ,肿瘤的数目、病灶有无复发或转移以及肿瘤的分化程度对生存率的影响差异有显著性。结论　超声引导下经皮微波凝固治疗对单发结节、分化较好、且无复发转移的肝转移癌患者有较好的远期疗效。

Ultrasound-guided percutaneous microwave coagulation therapy for hepatic metastases

OBJECTIVE: To analyze the therapeutic results and prognostic factors of hepatic metastases treated by ultrasound-guided percutaneous microwave coagulation. METHODS: Seventy-four patients with 149 nodules of hepatic metastases were given percutaneous microwave coagulation therapy. The longest diameter of the metastatic nodule ranged from 0.7 - 6.8 cm (mean, 3.1 +/- 1.8 cm). The cumulative survival rate was analyzed by Kaplan-Meier method and the difference between groups was compared with log-rank test. Cox proportional hazard model was used to determine potential prognostic variables. RESULTS: The follow-up period for the 74 patients was 5 - 83 months (mean, 25.1 +/- 11.4 months). The overall 1-, 3-, and 5-year cumulative survival rates were 91.4%, 46.4% and 29.0%, respectively. The log-rank test showed that number of metastases, tumor size, tumor cell differentiation and local recurrence or new metastases were statistically significant prognostic factors; while age, sex and site of primary tumors were not significant prognostic factors. Multivariate analysis revealed that tumor differentiation, number of metastases and recurrence or new metastases were statistically significant prognostic factors. CONCLUSION: Ultrasound-guided percutaneous microwave coagulation therapy for hepatic metastases in patients with single metastasis, well-differentiated tumor, and without recurrence and new metastases could achieve long-term survival.