肝癌射频消融技术及疗效评价方法

目的 总结肝癌射频消融(RFA)的临床经验并探讨评价RFA疗效的方法 .方法 对49例肝癌病人进行了统一方案的RFA治疗,其中男43例,女6例;年龄39～72岁,平均(56.4±9.3)岁.肿瘤直径1.5～10 cm,其中≤3 cm 16例,3.1～5 cm 15例,>5 cm 18例.按肝功能Child-Pugh分级,A级41例,B级8例.病理诊断为肝细胞癌44例,胆管细胞性肝癌5例.采用RITA射频消融肿瘤治疗系统(RF-1500)行RFA.在RFA后3～4周常规行CT及TACE,以评价肝癌RFA的效果及巩固疗效.结果 全部病例RFA术后恢复顺利,总体1、2、3年生存率为77.5%、56.5%和44.0%,肝癌RFA后3～4周,AFP阳性(≥25μg/L)者转阴率62.9%(22/35).改进的肝癌RFA方法 可对直径5 cm以下的肿瘤进行比较彻底的消融,≤5 cm者1、2、3年生存率为100%、79.6%和61.9%.将肝癌消融近期疗效分为3个级别,RFA术后获得根治性消融(19例)、亚根治消融(9例)、姑息性消融(21例)者2年生存率分别为85.7%、60.0%和24.3%.结论 肝癌RFA相当于从机能上切除了肿瘤,肝癌消融近期疗效三级分类法可以比较客观地评价RFA的效果,以指导辅助治疗的选择.

Techniques of radiofrequency ablation for unresectable primary liver cancer and outcome evaluation

Objective To summarize the experience in treatment of unresectable primary liver cancer (PLC) with radiofrequency ablation (RFA) and evaluate the outcome. Methods Over a 3-year period, 49 consecutive patients with solitary or muhinodular PLC (Child-Pugh class A or B) under-went RFA. Histopathologic types were of hepatocellular carcinoma in 43 cases and of cholangio-carci-noma in 6. The tumor size was 1.5-- 10. 0 cm. RFA was performed by a RITA expandable electrode device(RF-1500) followed by TACE administration 3-4 weeks later. Local efficacy was evaluated with computed tomography (CT) performed at an average of 4 weeks after RFA treatment and then during follow-up. Results There were no severe complications after RFA in all the patients. The total 1, 2 and 3-year survival rates were 77.5%, 56.5% and 44.0%, respectively. Tumors no more than 5cm in diameter could be ablated inside out. The 1, 2 and 3-year survival rates were 100%, 79.6%, 61.9%, respectively. The treatment response of RFA was assessed as curative ablation (complete tumor ablation with 0.5-1 cm ablative margin) in 19 cases, sub-curative ablation (complete tumor ablation with less than 0.5 cm ablative margin) in 9 cases,non-curative (noncomplete) ablation in 21 cases. The 2-year survival rate was 85.7 %, 60.0% and 24.3%, respectively, in patients with differ-ent types of response. Conelusion RFA has similar effect as resection of PLC on small tumors. The classification method for the evaluation of RFA display the results in 3 grades, and it is useful for the selection of adjuvant therapy.