经皮肝穿刺射频热凝对复发性肝癌的治疗意义

目的 探讨对于无再次手术指征的复发性肝癌行B超引导经皮肝穿刺射频热凝(PRFA)治疗的意义。方法 1999年10月～2001年7月经病理证实为原发性肝癌，术后影像学和血清肿瘤标记物证实为肝癌复发的47患者进行B超引导PRFA治疗。复发瘤灶为单发者24例、多发者23例，其中复发灶为单发且小于3．5cm者12例。定期随访，复查AFP、肝功能和B超，1个月后复查MRI或CT了解肿瘤坏死情况，以后每3个月复查。Kaplan—Meier法计算累积生存率。结果 复发灶为单发者1、2、3年的生存率分别为65.2％、37．5％、37．5％，复发灶为单发且小于3.5cm者1、2、3年的生存率分别为83.3％、51．4％、51．4％。复发灶为多发者1、2年的生存率为41．7％、19．5％。结论 B超引导经皮肝穿刺射频热凝是肝癌综合治疗中一种重要手段，对于无再次手术指征的复发性肝癌可以根据复发瘤灶的大小、范围、复发时间，决定单独或结合TACE给予B超引导经皮肝穿刺射频热凝(PRFA)治疗，可以更加有效地控制复发、提高生存率。

Importance of percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma

Objective: To study the importance of percutaneous radiofrequency ablation (PRFA) guided by ultrasound for inoperable recurrent hepatocellular carcinoma. Methods: Forty-seven patients with inoperable recurrent hepatocellular carcinoma underwent percutaneous radiofrequency ablation (PRFA) under ultrasond between October 1999 and July 2001. Twenty-four patients had single recurrent tumor and 23 patients had multiple lesions. Twelve patients had single lesion with less than 3.5 cm in diameter. All patients were followed up to examine the value of AFP, MRI or CT after PRFA. Kaplan-Meier estimation was used to analyze the survival rate. Results: The 1-,2- and 3-year survival rate in single lesion group was 65.2%, 37.5% and 37.5% respectively. The survival rate of 1 and 2 years was 41.7% and 19.5% in the multiple lesions group. The 1-,2- and 3-year survival rate in single lesion groups with less than 3.5 cm in diameter was 83.3%, 51.4% and 51.4% respectively. Conclusion: PRFA is one of the important comprehensive methods for recurrent hepatocellular carcinoma. According to the size, number and recurrent time, PRFA can be performed separately or combined with transcatheter arterial chemoembolization for inoperable recurrent hepatocellular carcinoma. This method can control the recurrence and increase the survival rate effectively.