肝裸区肝细胞癌经皮射频消融治疗的疗效和安全性

目的 探讨CT引导下经皮射频消融(percutaneous radiofrequency ablation,PRFA)治疗肝裸区肝细胞癌(hepatocellular carcinoma in the bare area,HCCBA)的疗效和安全性.方法 回顾性总结作者在2000年4月至2009年6月间收治的肝细胞癌(hepatocellular carcinoma,HCC)病人的临床资料,共有26例早期HCCBA病人接受了CT引导下PRFA治疗,作为HCCBA组;在右肝非裸区HCC病人中,以癌灶距肝包膜、胆囊和第一肝门主要分支的距离≥1.0 cm为条件,纳入26例作为对照组.两组病人的年龄、性别、基础肝病原因、肝功能分级、癌灶直径等方面的差异无统计学差异(P>0.05).癌灶残留采用PRFA后1个月增强CT和(或)甲胎蛋白(alpha-fetoprotein,AFP)追踪判定,将完全消融至局部肿瘤复发的间隔时间作为无瘤生存时间.用t检验比较癌灶直径,用MannWhitney U检验比较年龄、肝病原因、肝功能分级、AFP水平和穿刺次数等指标,用χ2检验比较完全消融率和局部无瘤生存率等指标.结果 两组术后并发症、穿刺次数和完全消融率无统计学差异(P>0.05).HCCBA组1年、3年和5年局部无瘤生存率分别为88.5%、46.2%和19.2%,对照组分别为92.3%、53.8%和15.4%,两组间亦无统计学差异(P>0.05).结论 CT引导下PRFA治疗HCCBA是安全和有效的,可以作为治疗方案之一.

Therapeutic efficacy and safety of percutaneous radiofrequency ablation for hepatocellular carcinoma in bare area

Objective To assess the therapeutic efficacy and safety of CT-guided percutaneous radiofrequency ablation(PRFA) for hepatocellular carcinoma in the bare area (HCCBA). Methods During the period from April 2000 to June 2009, 26 patients with HCCBA were treated with CTguided PRFA, and 26 other HCC patients were selected as controls, whose lesions were located in the right lobe ≥1.0 cm away from the liver capsule, gallbladder, and main portal branches. One month after PRFA, the residual tumors of each patient were examined by contrast-enhanced CT and alpha-fetoprotein test, and repeated PRFA was undertaken if residual was present. Tumor-free survival was defined as the duration from complete ablation to diagnosed local recurrence. The 2-independent-samples t-test was used to compare tumor diameter between HCCBA patients and controls. The MannWhitney U test was used to compare patient's age, etiologies of liver disease, liver function status,number of needle punctures and the value of AFP. A χ2 test was used for comparison of the complete tumor ablation rate and the cumulative local tumor-free survival rate. Results No significant difference was observed in the incidence of complication between the HCCBA patients and the controls (26. 9% vs 19.2%,P＞0.05). There were no differences between the two groups in the number of needle punctures and the complete tumor ablation rate at first PRFA. Furthermore, no differences were observed in the cumulative 1-,3- and 5-year local tumor-free survival rates between HCCBA patients (88. 5%, 46.2% and 19. 2% respectively) and patients in the control group (92.3%, 53.8% and 15.4% respectively). Conclusion CT-guided PRFA is effective and safe for HCCBA and could be preferred as one therapeutic option for HCCBA.