超声引导经皮微波消融治疗肝癌的个体化方案及疗效

Tailored approach to sonographically guided percutaneous microwave coagulation therapy for hepatocellular carcinoma

目的:探讨超声引导经皮穿刺微波凝固治疗(PMCT)对邻近膈肌、肠管、胆囊和肝表面等难治部位肝癌的个体化治疗方案疗效。方法:采用超声引导经皮穿刺微波凝固(PMCT)治疗750例肝癌患者,共902个病灶,其中,176个病灶邻近肠管,383个病灶邻近膈肌,163个病灶邻近胆囊,180个病灶邻近肝表面。肿瘤最大径平均(4.0±2.2)cm(1.5-6.8)cm。对不同部位肿瘤建立相应的个体化方案指导治疗,1个月后行增强CT判断肿瘤早期灭活率并定期随访。结果:肿瘤早期总灭活率为90.3%;邻近肠管、膈肌、胆囊和肝表面的肿瘤早期灭活率分别为90.3%、89.5%、91.7%和93.1%,局部复发率分别为9.1%、9.9%、8.1%和7.0%。1、2、3年的生存率分别为81.9%、60.8%、50.6%。750例共1150人次,较严重并发症占3.7%。包括腹腔出血8例,邻近脏器(膈肌、肠管)损伤6人,针道种植9例,肝包膜下血肿15例,肝脓肿5例。共计43人次。结论:对PMCT易灼伤邻近肝外结构的难治性肝癌,本研究采用个体化方案策略指导治疗,获得较好的肿瘤灭活率并降低并发症,本方案拓展了肝癌PMCT治疗适用范围,有助于提高PMCT在肝癌综合治疗中的作用。

Objective：To evaluate the effectiveness of tailored approach to percutaneous microwave coagulation therapy for hepatocellular carcinoma（HCC）.Methods： Ultrasound-guided percutaneous microwave coagulation therapy was performed in 902 tumors of 750 patients,including 176 near the bowel,383 near the diaphragm,163 near the gallbladder,and 180 near the liver surface.The tumor sizes ranged 1.5-6.8 cm [mean（4.0±2.2）cm].A tailored treatment strategy was established for tumors in different locations Contrast-enhanced CT was performed one month later to evaluate the early necrosis rate of the treated tumors.Results： Early tumor necrosis rate was 90.3% of the peripherally located HCC,including 90.3% of the tumors near the bowel,89.5% near the diaphragm,91.7% near the gallbladder,and 93.1% near the liver surface.Local tumor recurrence rates were 9.1%,9.9%,8.1%,and 7.0% for tumors near the bowel,diaphragm,gallbladder,and liver surface,respectively.The 1-,2-,and 3-year survival rates of were 81.9%,60.8%,and 50.6%,respectively.Major complications occurred in 3.6%,including abdominal bleeding（n=3）,nearby structure injury（n=6）,needle tract seeding（n=9）,hepatic subcapsular（n=15） and liver abscesss（n=5）.Conclusion： The tailored approach to PMCT provides a promising treatment option for refractory peripherally located HCC with satisfactory tumor necrosis rate and low complication rate.