膈顶部原发性肝癌的射频消融

Radiofrequency ablation for the treatment of primary hepatocellular carcinoma located at hepatic dome

目的探讨膈顶部原发性肝癌射频消融(RFA)的治疗转归。方法2006年2月至2008年3月,共有251例原发性肝癌患者接受了超声引导下的经皮RFA,其中42例56个肿瘤位于膈顶部,定义为A组。另有209例368个肿瘤位于非膈顶部,定义为B组。结果初次RFA后,A、B两组的完全消融率、局部复发率及并发症发生率分别为85.7%比86.6%;9.5%比11.5%和7.1%比4.7%,差异均无统计学意义(P>0.05)。将B组按肿瘤具体部位进一步分为肝实质内、包膜下、空腔脏器旁以及肝门部肿瘤,再与A组比较,显示上述5个不同部位肿瘤完全消融率两组间差异有统计学意义(P<0.05)。膈顶部和非膈顶部直径<3 cm,3～5 cm和>5 cm肿瘤的完全消融率分别为90.2%,76.9%,50%和96.6%,78.1%,69.2%,两组同等直径范围肿瘤的完全消融率差异无统计学意义(P>0.05)。A、B两组1年无复发生存率分别为62.3%和59.2%,总生存率分别为90.0%和92.0%。2年无复发生存率分别为56.6%和52.4%,总生存率分别为82.7%和84.2%。A、B两组1、2年无复发生存率和总体生存率之间差异无统计学意义(P>0.05)。结论尽管膈顶部肿瘤位置的特殊性影响着RFA后疾病转归,但与其他部位肿瘤相比,膈顶部肿瘤在治疗效果、治疗风险、局部复发以及生存预后方面均不逊色,膈顶部肿瘤并非RFA的禁忌证。

Objective To investigate the complete ablation rate, the risk of complications and the local recurrence of primary hepatocellular carcinoma （HCC） located at hepatic dome after radiofrequency ablation （RFA） treatment. Methods During the period of Feb. 2006-March 2008, a total of 251 patients with HCC （total of 453 lesions） underwent RFA. In 42 patients, the HCCs （altogether 56 lesions） were located at hepatic dome, which was regarded as group A. The remaining 209 patients with a total of 368 lesions, which were not located at hepatic dome, were regarded as group B. The RFA procedure was performed via a pereutaneous approach in all patients. The ablation extent, the complications, the local recurrence and the survival rate were observed and analyzed. Results The complete ablation rate, the local recurrence rate and the complication occurrence were 85.7%, 9.5% and 7.1% respectively in group A, and were 86.6%, 11.5% and 4.7% respectively in group B. No significant difference in the above three results existed between two groups. The complete ablation rate of lesions with diameter less than 3 cm, 3-5 cm and larger than 5 cm was 90.2 %, 76.9% and 50% respectively in zroup A, and was 96.6%, 78.1% and 69.2% respectively in group B. For tumors with the same diameter, no significant difference in the complete ablation rate existed between two groups. The one-year recurrence-free survival rate of group A and group B was 62.3% and 59.2% respectively, while the overall one-year suivival rate of group A and group B was 90.0% and 92.0% respectively. The two-year recurrence-free survival rate of group A and group B was 56.6% and 52.4% respectively, while the overall two-year survival rate of group A and group B was 82.7% and 84.2% respectively. The difference in one- and two-year survival rate between group A and group B was of no statistical significance. Conclusion In treating HCC with RFA, the therapeutic effectiveness, the risk and the local recurrence of the lesions located at hepatic dome are comparable to that of the lesions located in other parts of the liver. Therefore, RFA is not contraindicated when HCC lesion is located at hepatic dome.