改良经皮微波消融术治疗肝癌的临床疗效观察

A modified percutaneous microwave ablation method for treatment of hepatocellular carcinoma:an observation on clinical therapeutic effects

目的改良经皮微波消融术治疗肝癌的策略与方法,简化治疗过程,提高疗效。方法用冷循环微波消融针治疗原发性肝癌92例(149个结节),平均直径(4.9±3.4)cm。采用不间断消融和环形不间断消融方式分别对直径6 cm以内及以上的瘤体进行消融治疗。瘤体直径4 cm以内,仅用微波消融。瘤体直径4 cm以上,微波消融术前采用肝动脉化疗栓塞(TACE),术中优先消融滋养动脉,6 cm以上瘤体采用环形不间断消融策略并加用双针消融。术后定期增强CT复查评价疗效,并观察1、2、3年生存率。结果一次性完全消融率为76.5%(114/149),二次完全消融率为86.6%(129/149),多次完全消融率为95.3%(142/149)。本组患者1、2、3年累计生存率分别为94.6%(87/92)、72.9%(62/85)、61.4%(35/57)。结论单一微波消融治疗对小肝癌疗效显著;TACE+滋养动脉优先消融+双针消融的组合策略是治疗巨块型肝癌的有效方法;环形不间断消融策略能大幅减少大肝癌消融布点、简化治疗过程,有可能成为追求巨块型肝癌原位灭活的新途径。

Objective To modify the strategy and methodology of percutaneous microwave ablation for treatment of hepatocellular carcinoma（HCC）,so as to simplify the therapeutic process and improve the therapeutic effect.Methods A total of 92 HCC patients with 149 nodes,with an average diameter of（4.9 ± 3.4） cm,were treated by the newly designed cooling circulation microwave electrode.Continuous ablation was used for tumors with diameters less than 6 cm and ring-shaped continuous ablation was applied for tumors with diameters more than 6 cm.Microwave ablation was used to treat tumors with diameters less than 4 cm.For tumors with diameters more than 4 cm,transcatheter arterial chemoembolization（TACE） was used before microwave ablation and nutrient arteries were given priority for ablation.Ring-shaped continuous ablation strategy and double antenna ablation strategy were adopted for tumors over 6 cm.Enhanced CT scans were performed at regular intervals to evaluate the therapeutic effect and the one-,two-and three-year survival rates were observed.Results（1） The complete necrosis rates for once,twice,and multiple ablations were 76.5%（114/149）,86.6%（129/149） and 95.3%（142/149）,respectively.（2） The one-,two-and three-year survival rates in our group were 94.6%（87/92）,72.9%（62/85） and 61.4%（35/57）,respectively.Conclusion Single microwave ablation is effective for small HCC.Double antenna ablation ＋ first ablation of nutrient artery ＋ TACE was effective for huge HCC.Ring shaped continuous ablation strategy can greatly reduce ablation points and simplify the ablation process,which is probably a new way for in situ complete necrosis of huge HCC.