CT引导下HITT治疗原发性肝癌和肝转移癌的探讨

Percutaneous CT-guided high frequency induced thermotherapy as a treatment hepatocellular carcinoma and hepatic metastatic lesions

目的探讨CT引导下HITT治疗原发性肝癌和肝转移癌的疗效,副作用和并发症。方法使用HiTT治疗36例原发性肝癌和肝转移癌病人(男24例,女12例)的42个病灶(其中6例病人有2个病灶)。36例病人中22例为原发性肝癌(HCC),14例为结直肠癌肝转移。肿瘤直径1.6～7.8cm(平均3.2cm)。其中HCC病人先行肝动脉化疗栓塞术(TAE),再行HiTT治疗。HiTT的治疗效果通过治疗后1个月复查螺旋CT评估。结果通过对术后1个月CT影像学资料的观察,结果显示30例原发性肝癌和肝转移的33(78%)个病灶完全坏死。肿瘤直径≤3cm的病灶完全坏死率为95%(18/19);3cm<肿瘤直径≤5cm的病灶完全坏死率为72%(13/18);5例肿瘤直径>5cm的病灶未呈现完全坏死。11个病灶显示不完全坏死,没有病人治疗后出现明显并发症。全部病人随访期内仍存活,随访期2～12个月(平均7个月)。结论本研究显示HiTT是治疗直径≤3cm经TAE治疗后的原发性肝癌和肝转移癌病人的一种安全和有效的方法,而它对3cm<肿瘤直径≤5cm的病灶相对有效。

Objective To analyze the efficacy, side effects and comp li cations of percutaneous high frequency induced thermotherapy (HiTT) performed un der CT guidance involving 36 patients with hepatocellular carcinomas (HCC) and h epatic metastatic lesions. Methods HiTT was performed in treatment of 36 patien ts (24 men and 12 women) with 42 hepatocellular carcinoma and hepatic metastatic carcinoma (six patient out of 36 had two nidi). The diameter of the tumors rang ed from 1.6 to 7.8 cm (mean, 3.2 cm). The efficacy of HiTT was evaluated with tr iphasic spiral CT performed 1 month after the procedure. Results The post-trea tment CT scan showed complete necrosis in 33 nidi (78% ) out of 42 nidi of hepa tocellular carcinoma and hepatic metastatic carcinoma in 30 patients out of 36. Complete necrosis was obtained in 18 (95% ) of 19 tumors no larger than 3 cm in diameter, 13 (72% ) of 18 tumors between 3.0 and 5.0 cm in diameter. Eleven tu mors showed incomplete necrosis. In our study, none of the patients experienced severe complications. All the patients are alive in the follow-up ranging from 2 to 12 months (mean, 7 months). Conclusion Our research suggests that HiTT can be a safe and effective treatment of hepatocellular carcinomas and hepatic meta static carcinoma when the lesion is no larger than 3 cm. The treatment is relati vely effective for hepatocellular carcinoma between 3 and 5 cm in size.