经皮热消融治疗可再手术切除的复发性肝细胞癌

Use of percutaneous thermal ablation for treatment of reoperable recurrent hepatocellular carcinoma after liver resection

目的评估经皮热消融治疗可再手术切除复发性肝细胞癌(RHCC)的临床疗效。方法 37例肝切除后 RHCC,肿瘤直径1.2～7.0 cm,平均(2.8±1.3)cm,临床评估可再切除但由于病人不愿意接受手术,采用超声引导经皮微波消融(MWA)或射频消融(RFA)治疗,观察局部疗效、治疗并发症和远期生存情况。结果肿瘤完全消融率(完全灭活率)91.9%(34/37),其中直径≤3 cm结节为95.8%、3 cm 以上者84.6%。并发症发生率5.4%(2/37),无治疗死亡。平均随访(20.5±14.4)个月,肿瘤局部复发与肝内远处复发率分别为21.2%、72.2%。消融后1、3年无瘤生存率分别为35.9%、17.4%,中位无瘤生存期为6.7个月;消融后1、3及5年累积生存率分别为70.0%、35.3%和35.3%,中位生存期为32.6个月;初次肝切除后1、3、5及10年生存率分别为85.1%、63.4%、41.0%和37.6%,中位生存期47.0个月。结论经皮热消融技术是可再手术切除 RHCC 的有效治疗手段。

Objective To investigate the clinical value of percutaneous thermal ablation （PTTA） for reoperable recurrent hepatocellular carcinoma （HCC） after liver resection. Methods Thirty-seven patients with reoperable recurrent HCC who declined to undergo re-operation were treated using ultrasound-guided percutaneous radiofrequency ablation or microwave ablation. There were a total of 37 tumor nodules with a diameter of 1.2-7.0 cm. Local therapeutic efficacy, complication incidence and long-term survival were evaluated. Results A complete ablation rate of 91.9% （34/37） was achieved, with 95.8% in tumors ≤3 cm and 84.6% in those 〉3 cm. The incidence of complications was 5.4% （2/37） and there was no treatment-related death. During a mean follow-up of 20.0±14.4 months, local recurrence and intrahepatic distant recurrence rates were 21.2% and 72.2%, respectively. The 1-and 3-year post-ablation disease-free survival rates were 35.9% and 17.4%, respectively. The mean disease-free survival time was 6.7 months. The 1-, 3-and 5-year post-ablation cumulative survival rates were 70.0%, 35.3% and 35.3%, respectively, with a median survival time of 32.5 months. The 1-, 3-, 5- and 10-year survival rates after initial liver resection reached 85.1%, 63.4%, 41.0% and 37.6%, respectively, with a median survival time of 47.0 months. Conclusions PTTA is an effective therapeutic alternative in selected patients with reoperable recurrent HCC after liver resection.