CT引导下经皮穿刺射频消融治疗特殊部位肝癌

目的 探讨CT引导下经皮穿刺射频消融（RFA）治疗特殊部位肝癌（直径≤3cm）的疗效及安全性。方法 回顾性分析2008年5月至2012年4月行CT引导下经皮穿刺RFA治疗47例肝癌患者，共消融63个特殊部位（指距离大血管、大胆管或肝外脏器5mm以内）病灶。所有患者术后均行增强CT复查及随访，统计肿瘤完全坏死率、肿瘤局部进展率、肿瘤肝内新生率、生存率及并发症。结果 所有患者均成功接受经皮穿刺RFA治疗。RFA术后1个月特殊部位肝癌完全坏死率为88.89％（56／63）；RFA术后3、6、12个月及1年以上的肿瘤局部进展率分别为4.77％（3／63）、3.17％（2／63）、3.17％（2／63）、1.59％（1／63），肿瘤肝内新生率分别为15.87％（10／63）、4.76％（3／63）、12.70％（8／63）、3.17％（2／63）。至随访截止时间，47例患者的1、3、5年生存率分别为82.98％（39／47）、63.83％（30／47）、36.17％（17／47）。RFA术后，未出现任何严重并发症，6例（12.77％）出现肝包膜下少量血肿，10例（21.28％）术后发热，经对症处理后症状改善。结论 CT引导下经皮穿刺RFA治疗特殊部位肝癌是安全、有效的方法。

CT-guided percutaneous radiofrequency ablation for specific-location hepatic carcinoma

Objective To investigate the efficacy and safety of CT-guided percutaneous radiofrequency ablation（ RFA） in the treatment of specific-location hepatic carcinoma. Methods From May 2008 to April 2012,47 patients with 63 maglignant hepatic lesions which are less than 3cm and close to the large vessels or important extrahepatic organs were treated by CT-guided percutaneous radiofrequency ablation. All patients were followed up by clinical and enhancements CT scan respectively in the first month,third month,sixth month,ninth month and twelveth month after RFA. The categorical data such as complete necrosis rate,local tumor progression rate,tumor intrahepatic recurrence rate and survival rate were analyzed. Results All patients were received CT-guided percutaneous radiofrequency ablation successfully. The complete necrosis rate of specific-location hepatic carcinoma was 88. 89%（ 56 /63） in one month after RFA. The local tumor progression rate was 4. 77%（ 3 /63）,3. 17%（ 2 /63）,3. 17%（ 2 /63） and 1. 59%（ 1 /63） respectively in the third,sixth,ninth and twelfth month after RFA. The tumor intrahepatic recurrence rate was 15. 87%（ 10 /63）,4. 76%（ 3 /63）,12. 70%（ 8 /63） and 3. 17%（ 2 /63） in the third,sixth,ninth and twelfth month after RFA. During the follow-up period,the1-,3-,5-year survival rates of 47 patients were 82. 98%（ 39 /47）,63. 83%（ 30 /47） and 36. 17%（ 17 /47） after RFA. No severe complications occurred. There were 6 cases complicated with hepatic sub-capsular hematoma,10 cases complicated with post-operative fever which were relieved by symptomatic treatment. Conclusion CT-guided percutaneous radiofrequency ablation for specific-location hepatic carcinoma was safe and effective.