超声引导经皮射频治疗肝脏良恶性肿瘤

Ultrasound-guided percutaneous radiofrequency ablation for benign and malignant liver tumors

目的 评价经皮射频 (PRFA)治疗肝脏良恶性肿瘤的效果、安全性及实用性。方法 应用RF 2 0 0 0射频仪和 10电极LeVeen射频针经皮穿刺治疗肝脏恶性肿瘤 114例 15 3个病灶和良性肿瘤 13例 16个病灶 ,共计 12 7例 16 9个病灶。B超引导监测 ,局麻配合全身镇痛处理 ,对于肿瘤病灶大于 2 5cm者进行分层多点叠合毁损 ,大于 5 0cm或多发的恶性肿瘤配合肝动脉导管化疗栓塞术 ,随访观察治疗效果、并发症和生存情况。结果 实施成功率 10 0 % ,PRFA治疗肝脏恶性肿瘤并发症发生率 6 14 % (7/114 ) ,均保守治愈 ,无相关死亡。PRFA治疗肝脏良性肿瘤未遇并发症 ,病人均健在。 114例肝脏恶性肿瘤病人的 3个月、6个月、1年、2年、3年生存率分别为 10 0 % (114 /114 )、97 4 % (111/114 )、74 6 % (85 /114 )、5 9 4 % (41/6 9)和 36 8% (7/19)。结论 PRFA微创、有效、简捷、实用、可重复、相对安全 ,在肝脏恶性肿瘤的综合治疗中有重要价值 ,亦可作为肝脏良性肿瘤的一种选择疗法。

Objective To assess the efficacy and safety of percutaneous radiofrequency ablation (PRFA) in treatment of benign and malignant liver tumors. Methods A total of 153 malignant liver tumors in 114 patients and 16 benign liver tumors in 16 patients were treated with ultrasound-guided PRFA using RF-2000 radiofrequency generator and 10-electrode LeVeen radiofrequency needle. Lesions larger than 2.5 cm in diameter were treated by multiple overlapping ablations encompassing the entire lesion as well as a rim of normal liver tissue (approximately 1.0 cm). The malignant tumors larger than 5.0 cm in diameter were treated by PRFA in combination with transcatheter arterial chemoembolization (TACE). Results The procedures were successfully performed in all the patients and severe pain, bleeding or bile leakage were not seen in patients with benign liver tumors during and after the treatment. Of the 114 patients with malignant liver tumors, the occurring rate of post-PRFA complications was 6.14% (7/114) and the patient's survival rate was 100% (114/114) in 3 months, 97.4% (111/114) in 6 months, 74.6% (85/114) in 1 year, 59.4% (41/69) in 2 years and 36.8% (7/19) in 3 years, respectively, after the treatment. Conclusions PRFA is mini-invasive, effective, simple, safe and repeatable so that it is of high value for comprehensive treatment of malignant liver tumors. Meanwhile, it can also be a choice for treatment of benign liver tumors in selected patients.