微波消融治疗肝脏恶性肿瘤的临床价值

Clinical Value of Microwave Ablation in Treating Malignant Liver Tumors

目的:探讨微波消融(MWA)治疗肝脏恶性肿瘤的临床疗效及并发症分析。方法:208例肝脏恶性肿瘤患者接受了241例次的MWA。肝细胞肝癌(HCC)171例行198例次的MWA,肿瘤总数301个,平均1.5个,肿瘤平均最大直径(2.9±1.3)em,其中57例接受了肝切除联合MWA;肝转移癌(MLC)37例行43例次的MWA,肿瘤总数67个,平均1.6个,肿瘤平均最大直径(2.6±1.5)cm。全组病例的治疗通过经皮和开腹两种途径,治疗后定期进行影像学和肿瘤标志物检查。结果:MWA 1个月后行增强CT检查,HCC 301个肿瘤中285个完全消融,完全消融率为94.7%(285/301),MLC 67个肿瘤中62个完全消融,完全消融率为92.5%(62/67)。随访3～43个月,HCC局部复发率为8.4%(24/285),1、2、3年生存率分别为89.0%、74.2%、53.6%,其中肝切除联合MWA治疗的患者1、2、3年生存率分别为81.3%、66.4%、46.7%;MLC局部复发率为9.7%(6/62),中位生存期17～23个月。HCC患者MWA的严重并发症发生率为2.5%(5/198),MLC患者的治疗未出现严重并发症。结论:MWA治疗肝脏恶性肿瘤创伤小,安全有效,具有重要的临床价值。

Objective： This study aims to explore the treatment effect and relevant complications of microwave ablation （ MWA ） therapy on malignant liver tumors. Methods： MWA was conducted in 208 liver tumor patients （ 241 surgical procedures ）. Among the total number of cases, MWA was conducted in 171 hepatocellular carcinoma （ HCC ） patients suffering from 301 tumors （average, 1.5 tumors; 198 procedures ）. The largest tumor diameter was 2.9 ~ 1.3 cm. Among the 171 HCC patients, 57 were subjected to MWA com- bined with hepatectomy. MWA was conducted in 37 metastatic liver cancer （ MLC ） cases suffering from 67 tumors （ average, 1.6 tu- mors; 43 procedures ）. The largest tumor diameter was 2.6±1.5 cm. All patients were treated with MWA via percutaneous or open sur- gery. Results： Contrast-enhanced computed tomography was performed 1 month after MWA. The complete ablation rate for HCC and MLC was 94.7% （285/301） and 92.5% （ 62/67 ）, respectively. The patients were followed-up for 3 months to 43 months. The local re- currence rate of tumors was 8.4% （ 24/285 ）, and the one-, two-, and three-year survival rates were 89.0%, 74.2%, and 53.6%, respec- tively. The one-, two-, and three-year survival rates of the patients who underwent MWA plus hepatectomy were 81.3%, 66.4%, and 46.7%, respectively. The local recurrence rate of tumors was 9.7% （ 6/67 ）, and the median survival time for the MLC patients ranged between 17 and 23 months. The rate of severe complications for the HCC patients undergoing MWA was 2.5% （ 5/198 ）. Severe compli- cations did not occur in the MLC patients. Conclusion： Treating malignant liver tumors through MWA is safe, effective, and less inva- sive. The clinical value is significant.