以射频消融为主的微创方式治疗肝癌术后复发

Percutaneous radiofrequency ablation combined with other minimally invasive treatments for recurrent hepatocellular carcinoma after hepatectomy

目的评价以射频消融为主的微创方式治疗肝细胞癌切除术后复发的疗效及安全性。方法回顾性分析1999年8月至2008年2月间接受以经皮射频消融为主的微创方式治疗的84例肝癌切除术后复发患者的临床资料。结果未见治疗相关性死亡，严重并发症发生率为2．4％（2／84），完全消融率为94．0％（79／84），治疗后1、3、5年总生存率分别为74．9％、54．9％、48．2％。肿瘤最大径43cm和〉3cm的患者治疗后1、3、5年总生存率分别为83．2％、67．7％、67．7％和59．1％、24．2％、12．1％（P=0．003），术后复发间隔时间≤1年和〉1年的患者治疗后1、3、5年总生存率分别为72．1％、36．2％、24．2％和76．8％、70．6％、65．1％（P=0．040）。结合和未结合瘤内无水酒精注射的患者术后1、3、5年总生存率分别为76．5％、57．3％、57．3％和66．7％、33．3％、22．2％（P=0．017）；结合和未结合经导管肝动脉栓塞化疗的患者治疗后1、3、5年总生存率分别为81．6％、66．0％、57．5％和55．6％、24．7％、24．7％（P=0．001）。结论射频消融是治疗肝癌切除术后复发安全、有效的手段，肿瘤大小和复发间隔是其疗效的重要影响因素。联合瘤内无水酒精注射或肝动脉栓塞化疗有助于提高射频消融对复发性肝癌的疗效。

Objective To evaluate the efficacy and safety of percutaneous radiofrequency ablation （PRFA） and combined with other minimally invasive treatments for recurrent hepatocellular carcinoma （RHCC） after hepatectomy. Methods Eighty-four patients with RHCC after hepatectomy who were treated with PRFA or combined with other minimally invasive therapies between August 1999 and February 2008 were analyzed retrospectively. Results There was no treatment related mortality in the study population, and the morbidity was 2.4% （2/84）. The complete ablation rate was 94. 0% （79/84） ,and the 1-,3- and 5-year overall survival rates were 74. 9% ,54. 9% and 48.2%, respectively. The 1-, 3- and 5-year overall survival rates of patients with recurrent interval after hepatectomy less than 1 year and over 1 year were 72. 1%, 36. 2% ,24. 2% and 76. 8% ,70. 6% and 65. 1% ,respectively （P =0. 040）. The 1-,3- and 5-year overall survival rates of patients with tumor size ≤ 3 cm and 〉 3 cm were 83.2% ,67.7% ,67.7% and 59.1%, 24. 2% ,12. 1% ,respectively （P=0. 003）. The 1-,3- and 5-year overall survival rates of patients treated with PRFA alone and combined with percutaneous ethanol injection （PEI） were 66. 7% ,33.3%, 22. 2% and 76.5% ,57.3% ,57.3%, respectively （ P = 0. 017 ）. The 1-, 3- and 5-year overall survival rates of patients treated with PRFA alone and combined with transcatheter hepatic arterial chemoembolization （TACE） were 55.6%, 24.7%, 24.7% and 81.6%, 66.0%, 57.5%, respectively （P=0.001）. Conclusions PRFA is an effective and safe treatment for RHCC, and tumor size and recurrent interval after hepatectomy are important prognostic factors. Combination with PEI or TACE may improve the efficacy of PRFA for treatment of RHCC.