经皮射频消融联合肝动脉栓塞化疗及酒精注射治疗复发性小肝癌

Percutaneous radiofrequency ablation combined with transcatheter arterial chemoembolization and percutaneous ethanol injection for recurrent small hepatocellular carcinoma

目的探讨经皮射频消融联合肝动脉栓塞化疗及酒精注射治疗复发性小肝癌的价值。方法回顾性分析2001年3月-2005年3月我院采用经皮射频消融治疗52例复发性肝细胞癌(肿瘤≤5cm)的临床资料,其中14例(肿瘤3～5cm)联合肝动脉栓塞化疗及酒精注射治疗。结果经皮射频消融治疗52例复发性小肝癌中,肿瘤<3cm者38例,MRI或CT显示全部瘤灶完全凝固性坏死;肿瘤3～5cm者14例,MRI或CT显示11例(78.6%)瘤灶完全凝固性坏死,联合肝动脉栓塞化疗及酒精注射治疗后全部瘤灶坏死。1、2、3、4年累积生存率分别为96.2%、69.4%、45.5%、30.0%。结论经皮射频消融是局部治疗复发性小肝癌的有效方法,对于<3cm的肿瘤可以完全灭活,对于3～5cm的肿瘤联合肝动脉栓塞化疗及酒精注射治疗有助于增加肿瘤的坏死率及提高患者的生存率。

Objective To explore the value of percutaneous radiofrequency ablation （PRFA） combined with transcatheter arterial chemoembolization （TACE） and percutaneous ethanol injection （PEI） in the management of recurrent small hepatocellular carcinoma. Methods Between March 2001 and March 2005, 52 patients with recurrent bepatocellular carcinoma （tumor size≤5 cm） underwent PRFA, and 14 of the patients （tumor size 3-5 cm） also received TACE and PEI, and their clinical data were analyzed retrospectively. Results MRI or CT after PRFA revealed complete coagulative necrosis of the tumor in 38 cases （tumor size 〈3 cm）. In the 14 patients （tumor size 3-5 cm） with also TACE and PEI, complete necrosis occurred in 11 cases （78.6%）. In the patients involved in this study, the 1-, 2-, 3- and 4-year survival rates were 96.2%, 69.4%, 45.5% and 30.0%, respectively. Conclusions PRFA is an effective modality for local treatment of recurrent small bepatocellular carcinoma, capable of total elimination of tumors 〈3 cm. For tumors of 3-5 cm, combination with TACE and PEI may help increase the tumor necrosis rate following the ablation and raise the patients＇ survival rate.