高强度聚焦超声治疗放疗后残留肝癌的初步临床观察

High intensity focused ultrasound for treating residual liver cancer after radiotherapy： primary clinical observation

目的 探讨高强度聚焦超声（HIFU）治疗放疗后残留肝癌的安全性和有效性.方法 HIFU治疗20例三维适形、立体定向放疗后25个肝癌残留病灶,比较HIFU治疗前、治疗后1周肝功能和血细胞变化,及治疗前、治疗后2周MRI、AFP变化,并行生存分析.结果 平均随访（12.6±8.0）个月,中位生存时间、1年生存率分别为22个月、87.5%.所有患者无皮肤烧伤.白蛋白、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、红细胞、白细胞、血小板HIFU治疗前与治疗后1周比较,差异无统计学意义（P=0.156、0.356、0.203、0.659、0.531、0.519、0.310、0.346）.AFP（9例阳性）HIFU治疗前与治疗后2周比较,差异有统计学意义（P=0.030）.MRI示16个病灶完整消融,6个消融体积≥80%.结论 HIFU可能是一种安全、有效治疗适形、立体定向放疗后残留肝癌的新方法.

Objective To investigate the safety and effect of high intensity focused ultrasound ablation（HIFU） on residual liver cancer in patients after radiotherapy. Methods Twenty liver cancer patients with twenty five residual tumors after three-dimensional conformal radiotherapy or stereotactic radiotherapy received HIFU ablation. Liver function and periphery blood cell counts were performed before HIFU and at 1 week after HIFU in all patients. Enhanced MRI and α-fetoprotein （AFP） level were performed before HIFU and at 2 weeks after HIFU to evaluate the effect of HIFU ablation. The survival of all patients was assessed by the Kaplan-Meier method. Results The mean follow-up time was （12.6 ± 8.0）months. The median survival time and 1-year survival rate were 22 months and 87.5% respectively. No skin burns were observed in all patients. As compared with before HIFU,there were no significant differences in the levels of albumin,alanine transarninase, aspartate transarninase, total bilirubin, direct bilirubin, blood red cell counts,blood white cell counts and blood platelet counts at 1 week after HIFU （paired t test, P =0. 156,0. 356,0. 203,0.659,0. 531,0. 519,0. 310,0. 346, respectively）. Significant difference in AFP level of 9 patients with AFP〉20 μg/L was observed before HIFU and 2 weeks after HIFU （paired t test, P =0.030）. Among 25 residual liver tumors,sixteen with complete ablation and six with ablation volume of ≥80% were observed by enhanced MRI at 2 weeks after HIFU. Conclusions HIFU may be a safe and effective new method to ablate residual liver cancer after three-dimensional conformal radiotherapy or stereotactic radiotherapy.