超声引导下经皮射频消融治疗肝脏恶性肿瘤的临床观察

Clinical Observation on the Effect of Radiofrequency Ablation Induced by Ultrasound on Liver Malignant Tumors

目的 探讨超声引导射频消融 (RFA)治疗原发性肝癌和转移性肝癌的方法及疗效。方法 采用美国RIFA射频肿瘤消融系统 15 0 0型主机 ,功率 15 0 0W ,RF发生器的频率为 460KHz。对原发性肝癌 2 7例 ,转移性肝癌 13例 ,共计 40例 5 7个病灶行超声引导RFA治疗。术后采用增强CT及彩超评价疗效。结果 RFA治疗后 1～ 12月复查 ,48个病灶完全凝固性坏死 ,有效率达84 2 % (4 8/5 7)有 3例患者 3个病灶局部复发 ,2例患者 6个病灶为肝内其它部位再发 ,对其进行再次重复治疗 ,取得满意结果。并发症 3例 ,1例损伤膈肌引起胸腔积液 ,经抽液治疗 ,胸水消失。 1例肝包膜撕裂 ,致肝包膜下积液 ,由于出血量少 ,未作特殊处理 ,两天后复查B超 ,积血吸收。 1例因病灶邻近胆囊 ,治疗中操作不当 ,灼伤胆囊引起胆瘘 ,后经处科手术治疗 ,因患者一般情况较差 ,术后因其他并发症死亡。结论 超声引导RFA治疗肝脏恶性肿瘤损伤小 ,并发症少 ,疗效确切。术前选择好适应症 ,术中正确熟练的操作方法 ,对于提高治疗效果 ,减少并发症的发生也是致关重要的。

Objective To explore the effect of of radiofrequency ablation induced by ultrasound (UI-RFA) on primary hepatocytocarcinoma(HCC) and metastatic liver cancers. Methods UI-RFA was performed on 27 cases of primary HCC and 13 cases of metastatic liver cancer, which included 57 lesions. The postoperative efficacy was evaluated by enhanced CT and colour Doppler ultrasound. Results 1～2 months after UI-RFA, 48 lesions were completely necrotized, and the effective rate was 84.2% (48/57). 3 lesions in 3 patients recurred, and 6 lesions in 2 patients recurred at other intrahepatic parts. After repeated therapy for the recurrent lesions, good outcome was obtained. 3 cases occurred complications. 1 case of pleural effusion caused by diaphragmatic damage vanished after aspiration. 1 case of liver capsule was lancinated, and led to the subcapsual effusion. Because of a little volume of bleeding, no management was performed. B-echography examination showed that the effusion was absorbed 2 days later. The last one, gallbladder fistula took place because of the lesion near to the gallbladder and intraoperative accidental misapply. After surgery, the general situation of the patient was awful, and died from other complications. Conclusion UI-RFA treated liver malignant tumors with less complications and good clinical outcome. Mastering operative indication, and correctly and skillfully operating were very important to improve efficacy and decrease complications.