CT引导二步法穿刺经皮微波凝固治疗肝动脉化疗栓塞术后原发性肝癌的临床应用

CT-guided two-step method puncture percutaneous microwave coagulation therapy to patients with hepatocellular carcinoma after TACE

目的评价CT引导微波凝固治疗（PMCT）肝动脉化疗栓塞（TACE）后原发性肝癌的临床应用。方法对33例确诊为原发性肝癌的患者，先行TACE治疗，2～4周后根据复查的AFP和影像学结果的情况决定再次行TACE或PMCT。行PMCT治疗的患者，应用“二步法”穿刺：定位后行穿刺道局部麻醉，首先以直径0．6mm、长8cm的腰穿针向肝内病灶穿刺；复查CT，根据骨穿针与病灶的角度和深度，再引入直径2．0mm、长13．5cm的微波天线引导针，针的头端超出病灶边缘约0．5cm，然后引入直径1．6mm的微波天线行微波治疗。所有的患者均得到随访，随访时间5～48个月（平均25．5个月），随访的内容包括影像学资料以及并发症。结果CT引导下行PMCT治疗TACE后肝癌，穿刺成功率100％，患者1、2、3年的累积生存率和复发率分别是84．23％、72．29％、61．96％和9．09％、24．24％、33．33％，出现肝脓肿2例，没有其他严重并发症。PMCT对肝功能的损害轻。结论CT引导下行TACE后肝癌的PMCT操作方便、定位准确，无严重并发症，临床疗效明确，有临床推广应用的价值。

Objective To evaluate the clinical application of CT-guided percutaneous microwave coagulation therapy （PMCT） to patients with hepatocellular carcinoma （HCC） after transarterial chemoembolization （TACE）. Methods Thirty-three patients with HCC undertook TACE first. They would undergo either TACE or PMCT based on the results of AFP and liver imaging such as CT/MR after 2 to 4 weeks of the primary TACE. Two-step method puncture was to perform puncture of guiding-needle of PMCT. Firstly, a lumbar-puncture needle （0.6 mm in diameter and 8 cm long） punctured the mass. Secondly, it was to reintroduce the guiding-needle （2.0 mm in diameter and 13.5 cm long） of PMCT, according to the angle and depth between the lumbar-puncture needle and the mass of recheck-CT. Then we introduced the antenna of PMCT and performed PMCT. All patients were followed up between 5 and 48 months （mean, 25.5 months）. Based on the results of follow-up, therapeutic effect, survival time and recurrence were prospectively evaluated with statistical analysis. Results The 1-, 2- and 3-year survival rate and the recurrence rate of the patients treated by TACE and PMCT were 84.23%, 72.29%, 61.96% and 9.09%, 24. 24%, 33.33%, respectively. Liver abscess （n=2） after PMCT was the only complication. PMCT had no other severe complications and its impairment to liver function was light. Conclusion CT-guided two-step method puncture PMCT to patients with HCC after treated by TACE is an easy and good-fixing operation. And it is safe, effective, practical and worth of clinic application.