超声引导下射频消融治疗原发性肝癌46例

Treatment of ultrasoundguided radiofrequency ablation for primary hepatic carcinoma: an analysis of 46 cases

目的:比较分析经皮射频消融术治疗原发性肝癌的疗效.方法:本院2003-03/2008-07收治肝癌患者46例,共69个结节,均经临床证实.患者予经皮射频消融治疗并跟踪随访.患者生存率以Kaplan-Meier模型及Log-rank检验进行单因素分析,完全消融率和局部复发率的比较采用卡方检验.结果:射频术后,直径<3cm的肿瘤完全消融率93.61%,局部复发率6.82%,1、2、3年的生存率为87.10%、80.13%和61.92%;直径≥3cm的肿瘤完全消融率68.18%,局部复发率27.27%,1、2、3年的生存率为73.33%、53.33%和30.48%.单个病灶的完全消融率90.00%,局部复发率10.00%,1、2、3年的生存率为90.00%、82.80%和63.98%;多发病灶者,完全消融率82.05%,局部复发率15.38%,1、2、3年的生存率为68.75%、50.00%和28.57%.Child-pugh A级组完全消融率87.93%,局部复发率13.21%,1、2、3年的生存率为86.40%、75.25%和54.99%;B-C级组完全消融率81.82%,局部复发率22.22%,1、2和3年的生存率为66.67%、53.33%和35.56%.结论:射频消融治疗肝癌的完全消融率和局部复发率与肿瘤的大小相关;长期生存率和肿瘤的数目、大小、肝功能分级相关.

AIM： To compare and analyze the therapeutic efficacy of ultrasound-guided radiofrequency ablation （RFA） for the primary hepatic carcinoma. METHODS： A total of 46 patients with 69 nod- ules of the primary hepatic carcinoma were treated at our hospital from March 2003 to July 2008. All patients were clinically diagnosed, treated with RFA and followed up. Patients＇ survival rates were analyzed using Kaplan-Meier model and Log-rank test, the complete ablation rate and the local recurrence rate were calcu-lated using %2 test RESULTS： After RFA treatment, the complete ablation rate, the local recurrence rate, the 1-, 2-, and 3-year survival rates were 93.61%, 6.82%, 87.10%, 80.13%, 61.92% respectively in the patients with the nodule 〈 3 cm, and were 68.18%, 27.27 %, 73.33%, 53.33%, 30.48% respectively in the patients with the nodule ≥ 3 cm; the complete ablation rate, the local recurrence rate, the 1-, 2-, and 3-year survival rates were 90.00%, 10.00%, 90.00%, 82.80% and 63.98% for the patients with the single nodule and were 82.05%, 15.38%, 68.75 %, 50.00 % and 28.57% respectively for those with multiple nodules; the complete ablation rate, the local recurrence rate, the 1-, 2-, and 3-year survival rates, were 87.93%, 13.21%, 86.40%, 75.25% and 54.99% respectively for the patients in Child-Pugh classification A, and 81.82%, 22.22%, 66.67%, 53.33%, 35.56 respectively for those in Child-Pugh classification B and C. CONCLUSION： The complete ablation rate and the local recurrence rate of RFA treatment on PHC are related to the size of the nodules; the long-term survival rate is related to the number, size of the nodules and liver function.