经皮射频联合肝动脉导管化疗栓塞治疗大肝癌疗效分析

Efficacy evaluation of percutaneous radiofrequency ablation in combination with transcatheter arterial chemoembolization for large hepatocellular carcinoma

目的 评价经皮射频（PRFA）联合肝动脉导管化疗栓塞术（TACE）治疗大肝癌的疗效。方法 应用RF-2000射频仪和10电极LeVeen射频针经皮穿刺热消融治疗76例大肝癌患者81个病灶（肿瘤直径5．1～15．0cm），PRFA前后联合TACE治疗，随访观察治疗效果、并发症和患者生存情况。结果PRFA操作均顺利完成。并发症6．58％（5／76），包括电极片灼伤皮肤2例，胆漏1例，腹腔出血1例，急性胆囊炎1例。PRFA相关死亡1例，该患者PRFA治疗后3天死于脑梗死。TACE无并发症。随访16～62个月，随访率92．1％，患者血清AFP下降89．3％，缓解率98．6％，6个月、1年、3年生存率分别为98．6％、72．9％和30．6％。结论PRFA联合TACE能发挥互补增益作用，是治疗大肝癌的一种有效备选方案。

Objective To assess the local treatment efficacy of percutaneous radiofrequency ablation（PRFA）therapy in combination with transcatheter arterial chemoembolization（TACE）for the large hepatocellular carcinoma（HCC）.Methods Eighty-one lesions ranged 5.1-15.0 cm in diameter in 76 patients with HCC were treated by PRFA in combination with TACE.RF-2000 generator and 10-needle LeVeen electrode were used percutaneously guided by B-ultrasound.Lesions were destroyed by multiple overlapping thermal ablations encompassing the entire lesion lesion as well as a rim of normal liver tissue （approximately 1.0 cm）.TACE was applied pre-and post-PRFA.Patients＇ survival rate and lesions＇ necrosis were evaluated.Results The procedures were performed successfully in all patients.Of 76 patients wity HCC,the post-PRFA complication rate was 6.58%（5/76）,including II skin burn（2）,bile leakage（1）,abdominal haemorrhage（1）,and acutecholecystitis（1）.PRFA-ralated death death rate was 1.32%（1/76）,and a 75 year-old man died on post-PRFA day 3 due to cerebral infarction.TACE were carried carried out without any complication.The follow-up rate was 92.1%,wity 16-62 months follow-up period（mean,38 months）.The level of serum AFP was ceclined in 89.3% of the patients.Six cases（8.6%） achieved a complete response（CR）,and 63（90%） achieved a pqrtial response（PR）.The effective rate （CR＋PR） was 98.6%.The patients＇ survival rates were 98.6% at 6 months,72.9% at 1 year,and 30.6% at 3 years,respectvely.Conclusion The results of this study suggest that PRFA plus TACE is an effective mini-invasive combined therapy and can be a choice of treatment regime for the large HCC in properly celective patients.