射频消融或联合经皮瘤内无水乙醇注射治疗小肝癌181例疗效分析

Radiofrequency ablation with or without percutaneous ethanol injection in the treatment of 181 cases of small hepatocellular carcinoma

目的总结经皮射频消融(radiofrequency ablation, RFA)治疗小肝癌的疗效. 方法应用RFA治疗小肝癌(≤5 cm)181例,其中RFA治疗128例,经皮瘤内无水乙醇注射(percutaneous ethanol injection, PEI)-RFA治疗53例. 结果全部病例随访1～46月(中位时间17月).1,2,3年生存率分别为89.47%,74.42%,49.88%.单发病灶直径＜3.0 cm组,1,2,3年生存率分别为94.63%,83.69%,70.47%;单发直径3.0～5.0 cm组为89.01%,69.39%,50.11%;多发病灶直径之和≤5.0 cm 组为78.28%,62.82%,0(P=0.041 9).RFA,PEI-RFA组1,2,3年生存率分别为88.23%,73.58%,45.97%和92.73%,76.83%,76.83%(P=0.316 8). 结论 RFA是一种安全有效的治疗手段,其结果受病灶大小和肿瘤数目的影响,与PEI联合应用或许可以提高疗效.

Objective To summarize the effectiveness of radiofrequency ablation (RFA) with or without percutaneous ethanol injection (PEI) in the treatment of small hepatocellular carcinoma. Methods A series of 181 patients with small hepatocellular carcinoma (≤5 cm) were treated by either RFA alone (128 patients) or RFA-PEI (53 patients). Results All the patients were followed up for 1~46 months (median, 17 months). The 1-, 2- and 3-year survival rates were 89 47%, 74.42% and 49 88%, respectively. When the patients were separated into 3 groups according to the size of tumors, the 1-, 2- and 3-year survival rates in patients with solitary tumor <3 0 cm in diameter were 94 63%, 83 69% and 70 47%, in patients with solitary tumor 3 0~5 0 cm in diameter were 89 01%, 69 39% and 50 11%, and in patients with multiple lesions ≤5 0 cm in the sum of diameters,78 28%, 62 82% and 0, respectively ( P =0 041 9). The 1-, 2- and 3-year survival rates in RFA patients and RFA-PEI patients were 88 23%, 73 58% and 45 97%, and 92 73%, 76 83% and 76 83%, respectively ( P =0 316 8). Conclusions RFA is an effective and safe therapeutic option but its effectiveness is influenced by the size and number of tumors. Combined use of RFA and PEI may or may not enhance the effectiveness.