CT引导下经皮射频消融治疗较大原发性肝癌的临床应用

Clinical application of CT-guided percutaneous radiofrequency ablation for the treatment of larger hepatocellular carcinomas

目的探讨CT引导下经皮射频消融(RFA)治疗较大原发性肝癌的疗效。方法对27例TACE治疗效果欠佳的较大原发性肝癌患者行CT引导下经皮RFA治疗,肿瘤大小5.4～11.0 cm,平均6.2 cm,单发病灶23例,2个病灶4例,共31个病灶。AFP阳性22例。术后通过增强CT及AFP检测评价疗效,所有病例随访2～20个月。结果射频治疗后1个月随访显示,31个肿瘤中14个(45.2%)肿瘤完全坏死,内部及边缘无明显强化;17个肿瘤部分坏死。22例AFP阳性患者,AFP明显降低15例(68.2%),不变3例(13.6%),升高4例(18.2%)。并发症中3例出现表皮烫伤,1例顽固性呃逆,1例肝内出血,1例肝脓肿,1例术后出现严重低蛋白血症,术后2个月死亡。患者中位生存期为9.8个月,1年累计生存率29%。结论对于不可切除的较大原发性肝癌,RFA是较有效的局部介入治疗方法,合理应用RFA治疗,可提高患者生活质量并延长患者的生存时间。

Objective To investigate the therapeutic efficacy of CT-guided percutaneous radiofrequency ablation （RFA） for the larger hepatocellular carcinomas. Methods CT-guided RFA was performed in 27 patients with larger hepatocellular carcinoma （total of 31 lesions）, who showed poor response to transcatheter arterial chemoembolization （TACE） treatment. The diameter of the lesions was 5.4-11 cm, with a mean diameter of 6.2 cm. Positive AFP was detected in 22 patients. The therapeutic efficacy was evaluated with enhanced CT scanning and AFP. All patients were followed up for 2 - 20 months. Results Follow-up checkups were carried out one month after RFA treatment. Of 31 lesions, complete necrosis was demostrated in 14 （45.2%） and partial necrosis in 17 （54.8%）. On enhanced CT scans, no obvious enhancement in the center or at the margin of the complete necrotic lesions was seen. Of 22 patients with positive AFP, the AFP level was markedly reduced in 15 （68.2%）, unchanged in 3 （13.6%） and elevated in 4 （18.2%）.Complications occurred in 7 patients, including epidermal scald （n = 3）, refractory hiccup （n = 1 ）, intra- hepatic hemorrhage （n = 1）, hepatic abscess （n = 1） and severe hypoproteinemia （n = 1, died 2 months after RFA）. The median survival period was 9.8 months and the one-year cumulative survival rate was 29%. Conclusion RFA is an effective treatment for unresectable and larger hepatocellular carcinomas. When this local interventional therapy is employed properly, it can obviously improve the patients＇ living quality and prolong their surviving span.