射频消融联合缓释化疗粒子植入治疗结直肠癌肝转移

Radiofrequency ablation combined with implantation of slow-release seeds in treatment of colorectal hepatic metastic carcinoma

目的探讨超声引导射频消融联合缓释化疗粒子植入对结直肠癌肝转移的治疗效果及临床应用价值。方法对不宜手术、放疗化疗或不愿接受手术治疗的结直肠癌肝转移患者58例（89个病灶）行超声引导下射频治疗，同时植入缓释化疗粒子。本组肿瘤直径2．3～6．7cm（中位数3．3cm），36例为单发灶，余22例为2个以上病灶；术后采用CT增强扫描为主结合彩色多普勒超声、肿瘤标记物等检查方法综合评价疗效。结果1个月后CT增强扫描显示87个病灶完全失去活性，近期有效率达97．7％。局部复发1例，肝内其他部位再发1例，而行第2次治疗。全部病例经3～18个月随访，目前存活52例，射频治疗后肿瘤缩小者行手术治疗2例，因手术并发症死亡，因脑和（或）肺广泛转移死亡4例。结论超声引导射频消融联合缓释化疗粒子植入术可作为结直肠癌肝转移的一种微创局部治疗方法，其并发症少，缓解率高，是一种安全、有效的新手段。

Objective To study the efficacy and the clinical value of ultrasound-guided radiofrequency ablation （RFA） plus implantation of slow-release seeds in the treatment of liver metastases from colorectal cancer. Methods Fifty-eight patients （89 liver metastatic lesions）, who were neither appropriate candidates for resection, chemotherapy and radiotherapy nor willing to undergo resection, were treated with RFA combined with implantation of slow-release seeds.. The lesion sizes ranged in diameter from 2.3-6.7 cm（mean 3.3 cm）. 36 patients had single tumor lesion, the remaining 22 patients had multiple lesions. The therapeutic response was assessed after treatment by contrast-enhanced spiral CT primarily, color ultrasound and tumor marker. Results Eight-seven lesions were completely ablated according to the results of contrast-enhanced spiral CT one month after RFA（response rate 97.7 %）. There were one patient with local recurrence, and one patient with multi-focal recurrences in the liver, who were treated with RFA again. In a follow-up program of 3-18 months,52 patients were alive to date,and 2 died of surgical complications and 4 brain and/ or lung metastases. Conclusion Ultrasound-guided RFA plus implantation of slow-release seeds seems to be an effective,safe treatment with low complication rate and minimally-invasive technique.