超声引导经皮细刀头氩氦刀靶向冷冻治疗肝癌

Ultrasound-guided minimally invasive targeting Argon-Helium cryoablation in the treatment of hepatic carcinoma

目的探讨经皮细刀头氩氯刀靶向冷冻治疗肝癌的有效性及安全性。方法从2006年6月至2007年6月，广东省佛山市第一人民医院在超声引导下采用Cryo—Hit氩氦刀1.47mm细刀头对26例原发性肝癌、15例复发性肝癌和13例转移性肝癌总共105个瘤灶（直径0．8—12．0cm）经皮靶向冷冻治疗。每3—6个月复查血清肿瘤标记物、B超、CT或MR评价瘤灶坏死情况，采用Kaplan．Meier统计分析存活率。结果原发性肝癌组、复发性肝癌组以及转移性肝癌组术后1年累积存活率分别为81.82％、46．22％和80．21％。术后复查B超、CT或MR均提示瘤灶不同程度的缩小甚至消失，对于直径〈3cm的肿瘤完全坏死率达96．2％，直径3—5cm的肿瘤完全坏死率达90．6％，直径〉5cm的肿瘤完全坏死率达28．6％。无出血、胆漏等严重并发症发生。结论超声引导经皮细刀头氩氦刀靶向冷冻治疗肝癌是继射频、微波之后又一安全、有效的经皮局部消融治疗新方法，其远期疗效还有待长期随访观察。

Objective To explore the effectivity and safety of minimally invasive targeting Argon-Helium cryoablation in the treatment of hepatic carcinoma. Methods Ultrasound-guided Argon-Helium targeting cryoablation using the Cryo-Hit system with 1.47mm fine probe was performed percutaneously in 26 cases of primary hepatic carcinoma, 15 cases of recurrent hepatic carcinoma and 13 cases of metastatic carcinoma with a total of 105 foci between June 2006 and June 2007 in the First People＇ s Hospital of Foshan. Serum tumor markers were detected and tumor necrosis was evaluated by ultra- sonography,CT scan or MRI every 3 to 6 months. Survival rate was analyzed with Kaplan-Meier method. Results One- year cumulative survival rates of primary, recurrent and metastatic hepatic carcinoma were 81.82%, 46. 22% and 80. 21% respectively. Tumor foci diminished in different degrees or even disappeared when performed ultrasonography, CT scan or MRI after the procedures, Tumor complete necrosis rate could reach 96. 2% to the foci less than 3cm,and they were 90. 6% to the foci between 3cm to 5cm in size and 28. 6% to the foci larger than 5cm. No complications such as bleeding or bile leakage were found. Conclusion Ultrasound-guided targeting treatment of hepatic carcinoma with Argon- Helium cryoablation using fine-probe Cryo-Hit system is a new, safe and effective procedure coming after radio-frequency and microwave ablation, although its long-term curative effects needs long-term follow-up survey.