经肝动脉化疗栓塞-冷循环微波刀序贯治疗肝癌的临床应用研究

The study of clinic application of transcatheter arterial chemoembolization and cooled-tip ablation in treating primary hepatocellular carcinoma

目的评价经肝动脉化疗栓塞-冷循环微波刀序贯治疗对肝癌的安全性和有效性。方法60例肝癌患者接受治疗,瘤块体积均大于5cm。其中仅27例瘤块为单个,其余33例为多个,但均不超过6个。所有病例均经过全面评价,均失去最佳手术切除时机。化疗栓塞采用经皮经肝动脉插管,1周后常规复查CT观察碘油沉积情况,如果肿瘤被栓塞不完全充分,则予冷循环微波刀治疗。结果中位随访期12个月(6～18个月),CT随访显示,128个肿瘤结节中,108个病灶(占84.3%)为完全坏死,16个病灶(占12.76%)为不完全坏死,4个(3.1%)病灶为部分坏死。其中44个原发癌灶中36完全坏死(占80.3%),16个转移癌灶中12个完全坏死(占75%)。结论经肝动脉化疗栓塞-冷循环微波刀序贯治疗肝癌效果良好,能明显使肿瘤缩小甚至消失,是一种微创、有效的治疗方法。

Objective To comment the safety and effect of combining cooled-tip electrodes and transcatheter arterial chemoembolization（TACE）for the treatment of patients with primary hepatocellular carcinoma.Methods Sixty patients（totally with 128 tumors）with primary hepatocellular carcinoma underwent the treatment of combination of radiofrequency ablation with cooled-tip electrodes and TACE.Results During or after operations：sinus bradycardia,hyperkalemia and acute pancreatitis.CT scan obtained after RF ablation showed that complete necrosis was achieved in 108 tumors（84.3%）,nearly complete necrosis in 16 tumors（12.76%）and partial necrosis in 4 tumors（3.1%）in 128 tumors nodules.All patients were followed up ranging from 6 months to 18 months.Conclusions The therapy combining RF ablation with cooled-tip electrodes and TACE for patients with primary hepatocellular carcinoma is effective and safe.