经皮射频联合无水酒精注射治疗第一肝门区肝癌

Treatment of liver cancer located in the first porta hepatis with percutaneous radiofrequency ablation combined with ethanol injection

目的探讨对于位于第一肝门区的小肝癌行B超引导经皮肝穿刺射频消融(PRFA)联合瘤内无水酒精注射(EI)治疗的可行性、疗效和应注意的问题。方法选择肿瘤位于第一肝门区、直径≤5 cm、病理或临床证实为原发性或继发性肝癌的26例患者进行PRFA+EI治疗。治疗前甲胎蛋白(AFP)阳性者治疗后定期复查AFP。治疗后1个月复查MR I、彩超或CT确定肿瘤是否完全坏死,以后每3个月定期复查。计算肿瘤原位复发率和累积生存率。结果AFP转阴率约为76.9%(10/13),MR I或CT显示第一肝门区肿瘤完全凝固坏死率为84.6%(22/26)。0.5、1年肿瘤原位复发率分别为23.1%(6/26)、26.9%(7/26),1、2、3年累积生存率分别为92.3%(24/26)、82.3%(14/17)、75.0%(9/12),无胆管狭窄发生。结论第一肝门区小肝癌并非PRFA治疗的禁忌证,只要治疗时穿刺点选择恰当、穿刺路径合理、超声监测下电极展开确切、热凝范围控制恰当,对于第一肝门区小肝癌PRFA+EI治疗是一种行之有效的治疗方法。

Objective To investigate the feasibility, curative effect and problems of combined ultrasound-guided percutaneous radiofrequency ablation and ethanol injection （ PRFA ＋ EI） on small liver cancer located in first porta hepatis. Methods Twenty - six patients, who diagnosed as primary and metastatic liver cancer that located in first porta hepatis and was less than 5 cm in diameter by clinical evidence or pathology, were performed PRFA ＋ EI between Jan 2001 and Oct 2004. The necrosis of the tumors was determined by MRI, Doppler ultrasound or CT after the treatment for one month and the regular examinations were tested every 3 months. The primary tumor recurrence rate and cumulative survival rate were calculated. Results The seroconversion rate of AFP was 76. 9% （10/13）. The complete necrosis rate of liver cancer in first porta hepatis was 84. 6% （22/26） by MRI and CT. The primary tumor recurrence rate of 6 months and 1 year were 23.1% （6/26） and 26. 9% （7/26）, respectively. The 1 - ,2 - ,3 -year cumulative survival rate were 92. 3% （24/26）, 82. 3% （ 14/ 17）, 75.0% （9/12）, respectively. There was no occurrence of bile ducts stenosis. Conclusion The small live cancer located in first porta hepatis is not the contraindication of PRFA ＋ EI. If the puncture point and route is selected properly, electrodes deployed exactly using ultrasound guidance and the size of heating area controlled appropriately, the PRFA ＋ EI is an effective treatment for small liver cancer located in first porta hepatis.