多电极组合穿刺在较大肝癌射频消融中的应用

Application of echo-guided percutaneous radiofrequency ablation by using a LeVeen needle electrode combination in the treatment of large liver tumor

目的总结应用多电极组合布针+多位点叠合射频消融(RFA)治疗较大肝癌(肿瘤最大直径>4 cm)的疗效,探讨电极针应用数量和布针方式与疗效的关系。方法2006年2月到2008年12月,共对113例失去手术机会的较大肝癌患者实施了超声引导下经皮肝RFA。所有肿瘤按大小分成A、B、C、D 4组。A组肿瘤直径4.0～5.0 cm;B组肿瘤直径5.1～6.0 cm;C组肿瘤直径6.1～7.0 cm;D组肿瘤直径7.1～9.3 cm。根据肿瘤不同直径决定应用的电极针数量及消融位点数目。术后随访评估治疗后肿瘤凝固性坏死结果及局部复发状况。结果RFA后2个月内首次复查,A、B、C、D 4组患者的完全消融率分别为88.4%,78.6%,63.6%和40.0%,总体完全消融率为79.7%。随访3～36个月,A、B、C、D组的局部复发率分别为5.5%,10.0%,28.6%和50.0%,总体局部复发率为10.5%。残留以及局部复发的肿瘤根据不同情况接受再次RFA、TACE或放疗。结论多电极组合布针+多位点叠合RFA治疗较大肝癌疗效确切,简单实用,但最好结合其他治疗方式以提高完全消融率。

Objective To evaluate the therapeutic effectiveness of echo-guided percutaneous radiofrequency ablation （RFA） by using a LeVeen needle electrode combination in the treatment of large liver tumor, and to discuss the relationship between the amount as well as the distribution pattern of the electrodes and the therapeutic effectiveness. Methods During the period of Feb. 2006-Dec. 2008, echo-guided RFA was performed in 113 patients with large and unreseetable liver tumor, with a total of 118 lesions. According to the size of the tumor, the patients were divided into four groups. The tumor＇s diameter of Group A （n =64） was 4.0-5.0 cm, Group B （n = 28） was 5.1 - 6.0 cm, Group C （n = 11） was 6.1 - 7.0 cm and Group D （n = 10） was 7.1 - 9.3 cm. Based on the tumor＇s diameter, the amount of the electrodes to be used and the sites to be ablated were determined. After the procedure, the follow-up checks with MRI or CT scanning were carried out to observe the necrotic extent and the local recurrence. Results Two months after the treatment, the complete necrosis rate of the tumor in Group A, B, C and D was 88.4%, 78.6%, 63.6% and 40.0%, respectively, with an overall necrosis rate of 79.7% in total 118 lesions. During a follow-up period of 3 - 36 months, the local recurrence rate in Group A, B, C and D was 5.5%, 10.0%, 28.6% and 50.0%, respectively. Severe complications, including intrahepatic infection （n = 2）, puncture passage bleeding （n =1 ）, symptomatic pleural effusion （n = 4） and biloma （n = 2）, occurred in 9 cases. No death related to RFA treatment occurred. Conclusion Echo-guided percutaneous radiofrequency ablation by means of multi-sites superimposition method with a LeVeen needle electrode combination is an safe and effective therapy for the hepatic tumors with the diameter over 4 cm.