射频消融术治疗肝癌的临床疗效与并发症观察

The therapeutic effects and complications of radiofrequency ablation for hepatocellular carcinoma

目的观察与分析经皮射频消融术（RFA）治疗原发性肝癌的临床疗效和并发症。方法从2000年1月～2007年6月，B超引导下对256例原发性肝癌患者行354例次RFA，治疗前后行AFP、B超或CT检查，治疗后随访，最长随访5年以上。结果2例治疗后24h内出现严重并发症而死亡。RFA术后并发症有：感染、发热223例次（62．99％），肝细胞明显损害117例次（33．05％），黄疸明显加重67例次（18．92％），血性腹水14例次（3．95％），气胸3例次（0．84％），消化道出血2例次（0．56％）。治疗后随访到6月者187例，AFP下降50％者129例（68．98％），死亡23例，存活164例（87．70％）。随访1年者129例，AFP下降50％者67例（51．93％），死亡37例，存活92例（71．3l％）。随访3年者83例，AFP下降50％者28例（37．73％），死亡5l例，存活32例（38．55％）。随访5年者56例，AFP下降50％者12例（21．42％），死亡44例，存活12例（21．42％）。肝脏肿瘤个数少和病灶体积小或者肝功Child-Pugh分级较好的患者生存率高。结论RFA具有简单、微创、安全、有效和反复治疗等优点，尤其对于无手术指征及TACE风险较大者。具有更重要的意义。当肿瘤〈5cm尤其是单个病灶或肝功Child-Pugh分级较好时效果更加明显。但并发症较多，长期疗效有待提高。

Objective To evaluate the therapeutic effects and complications of percutaneous radiofrequency ablation （RFA） for the treatment of hepatocellular carcinoma. Methods During January 2001 to June 2007, a total of 354 cases （256 patients） received percutaneous RFA under ultrasound guidance. AFP, B-U/S and CT examinations were conducted before and after the operation. A follow-up study was carried out with a maximum period of more than 5 years. Results Two patients were dead because of severe complications within 24 hours after treatment. Complications of RFA therapy included 223 cases of infection and fever （62.99%） , 117 cases of severe hepatocyte impaired （33.05%） , 67 cases of jaundice aggravate（ 18.92% ） , 14 cases of bloody ascites（ 3. 95% ） , 3 cases of pneumothorax （0.84%）and 2 cases of gastrointestinal hemorrhage （0.56%）. We followed up the patients after treatments for 6 months, 1, 3 and 5 years, the total numbers of patients were 187, 129, 83, 56 respectively. The numbers of patients whose AFP decent to 50% were 129 （68.98%） , 67 （51.93%） , 28 （37.73%） and 12 （21.42%） , respectively. The numbers of death were 23,37,51,44,respectively. The numbers of survival were 164 （87.70%） , 92 （71.31%） , 32 （38.55%） , 12 （21.42%） , respectively. Those factors such as less number of tumors, smaller tumor size and better Child-Pugh class grade were concluded to improve the survival rate of patients. Conclusion RFA therapy is a feasible, minimally inva- sive, safe, effective and reproducible treatment option, especially for the patients who have no surgical indication and TACE in danger. It can improve the curative effect for tumors size less than 5 cm or getting a better Child-Pugh class grade. However, cautions should be taken into consideration when performing RFA on patients because of it＇s complications. And long-term efficacy should be further improved.