射频消融治疗肝脏恶性肿瘤803例分析

Experience of radiofrequency ablation on liver malignancies:a report of 803 cases

目的总结射频消融治疗肝脏恶性肿瘤的疗效及影响因素。方法从1999年8月至2007年2月共应用射频消融治疗肝脏恶性肿瘤803例,其中原发性肝癌672例,肝转移瘤131例;超声引导781例,CT 引导8例,腹腔镜下9例,开腹直视下5例;射频消融结合经皮瘤内无水酒精注射术117例,射频消融结合经导管肝动脉化疗栓塞术108例。结果 803例肝脏恶性肿瘤射频消融治疗的病死率为0.25%,严重并发症发生率为0.37%,完全消融率为92.5%,局部复发率为13.8%,术后1、2、3、4、5年累积生存率分别为95.1%、85.6%、75.7%、60.7%、47.5%;672例原发性肝癌术后5年累积生存率分别为:Ⅰ a 期61.9%、Ⅰ b 期42.2%(P<0.01)。结论射频消融是肝脏恶性肿瘤安全、有效的治疗手段,肿瘤大小和分期是重要的影响因素。

Objective To summarize the 8-year experience of radiofrequency ablation （RFA） on liver malignancies and explore the effect and prognostic factors. Methods From August 1999 to February 2007,803 patients with liver malignancies, among which there were 672 with primary liver cancer （PLC） and 131 with liver metastasis, were treated with RFA. There were 781 cases who were performed pereutaneously under the guidance of ultrasound,8 cases under CT,9 cases with laparoseopy and 5 cases with laparotomy. And there were 117 cases who were treated by RFA combined with percutaneous ethanol injection and 108 cases by RFA combined with transeathetal arterial ehemoembolization. Results In the treatment of all the 803 patients with liver malignancies ,the mortality was 0. 25% ,the rate of severe complications was 0. 37%. The rate of complete ablation was 92. 5%, the loco-reeurrence rate was 13. 8% and the 1,2,3,4,5-year survivals were 95.1% ,85.6% ,75.7% , 60. 7% and 47.5% ,respectively. For the 672 patients with PLCs, the 1,2,3,4,5-year survivals with stage Ⅰ a （ Chinese staging system） were 97.8%, 91.5% , 84. 6% , 77. 1% and 61.9% , respectively, with stage Ⅰb were 93.9% , 83.7% , 69. 8% , 45.1% and 42. 2%, respectively ,with stage Ⅱ were 86. 2%, 67.3%, 47.3%, 17.2% and 0, respectively, and the 1,2-year survivals with stage Ⅲ were 67.8% and 0, respectively （ P 〈 0. 01 ）. Condusions RFA is a safe and effective method for liver malignancy, and the tumor size and stage are important prognostic factors.