超声引导经皮微波消融治疗早期原发性肝癌的远期疗效

Long-term results of percutaneous sonographically-guided microwave ablation therapy of early-stage hepatocellular carcinoma

目的 评价经皮微波消融治疗早期肝细胞肝癌患者的远期疗效。方法 自1994年5月至2004年6月，216例直径≤5．0cm的原发肝细胞肝癌患者共275个结节进行了经皮微波消融治疗（男性193例，女性23例；平均年龄54．68岁），所有病例均在我院诊治并签署知情同意书同意接受微波治疗。分析了肿瘤完全坏死率、远期生存率、复发率及并发症。结果 本组平均随访期为40个月±24个月（6～127个月）。随访中159例（73．61％）存活，57例（26．39％）死亡。微波消融后95．64％（263／275）的肿瘤呈完全灭活，患者1、2、3、4和5年的累计生存率分别为94、87％、88．81％、80．44％、74．97％和68．63％。微波消融后1、2、3、4和5年的累计复发率分别为20．01％、32．04％、39．57％、44．97％和52．90％，3例发生较严重的并发症，包括针道种植1例，胆瘘2例，1例于治疗后一周死于肺部感染。结论 超声引导经皮微波消融早期肝细胞肝癌在大部分病例可达到肿瘤完全坏死且并发症发生率较低，具有满意的远期临床疗效。

Objective To evaluate the long-term results of percutaneous microwave coagulation therapy in the treatment of early hepatocellular carcinoma. Methods From May 1994 to June 2004, a total of 216 patients with 275 nodules of hepatocellular carcinoma whose diameter ≤ 5 cm had undergone percutaneous microwave coagulation therapy （ 193 men, 23 women ; mean age, 54.68 years ） . Institute review board approval and informed consent were obtained. Complete tumor necrosis rates, long-term survival rates, recurrence rates and the complications of the patients were analyzed. Results The mean follow-up period after microwave ablation was 40 months ±24（range, 6 ～ 127 months）. One hundred fifty-nine remained alive and consulted our hospital periodically as outpatients. Fifty-seven patients died. Complete tumor necrosis was seen in 95. 64% （263/275） patients. One, 2, 3, 4 and 5-year cumulative survival rates were 94. 87%, 88. 81%, 80. 44%, 74. 97% and 68. 63% , respectively. One, 2, 3, 4 and 5-year cumulative recurrence rates were 20. 01%, 32.04%, 39. 57%, 44.97% and 52.90%, respectively. Three patients have severe complications, including needle track implantation in one patient, biliary fistula in two patients. One patient died of pulmonary infection one week after the treatment. Conclusion Sonographically-guided microwave coagulation therapy could make complete tumor necrosis in most cases of early hepatocellular carcinoma with low incidence of complications and this method has satisfactory long-term curative effect.