肝恶性肿瘤超声引导下射频消融短期有效性及影响因素分析

Evaluation of short-term efficiency and affecting factors of radiofrequency ablation guided by sonography in hepatic malignant tumors

目的评估肝恶性肿瘤超声引导下射频消融（radiofrequency ablation，RFA）的有效性及影响因素。方法回顾性分析2011年6月至2012年5月405例行超声引导下肝恶性肿瘤RFA治疗患者的临床资料，以及术前影像学检查和术后至少3个月随访影像学资料，分析肿瘤患者RFA后病灶完全消融率、局部残存率、肿瘤复发率及肿瘤进展率，并分析影响肝恶性肿瘤RFA局部疗效的相关因素。结果405例患者共行462次RFA治疗，消融病灶数610个，病灶直径（2．54±1．1）cm，术后3个月肿瘤完全消融率89．2％（544／610），肿瘤复发率17．5％（81／462），肿瘤进展率23．8％（110／462）。病灶数目（≥3个）、病灶大小（≥3cm）及肿瘤位置（位于大血管旁）影响肿瘤完全消融率；而病灶数目（≥3个）影响肿瘤复发率及进展率。复发性肝细胞性癌、胃肠道转移癌及非胃肠道转移癌相比原发性肝癌（HCC）有更高的复发率和进展率。结论超声引导下RFA治疗肝恶性肿瘤可有效控制肿瘤局部进展，病灶数目、大小及位于大血管旁可影响肿瘤完全消融率，病灶数目可影响肿瘤复发率及进展率，复发性HCC及转移性肝癌与原发性HCC相比肿瘤复发率、进展率更高。

Objective To evaluate the short-term efficiency and risk factors for effects after percutaneous radiofrequency ablation （RFA） for hepatic malignant tumors under the guidance of sonography. Methods The clinical data and the follow-up radiographic images of the patients with hepatic malignant tumors treated by percutaneous RFA were reviewed between June 2011 and May 2012, and the short-term incomplete ablation rate, recurrance rate and tumor progression rate were calculated, and the factors affecting the incomplete ablation rate, recurrence rate and progression rate were analyzed. Results 610 lesions were ablated in the total of 462 RFA procedures for 405 patients under the guidance of sonography with percutaneous method. The average size of the tumor was （2.5 ± 1.1）cm. During at least 3-month follow-up, complete and incomplete ablation rate was 89.2%（544/610） and 10.8%（66/610） separately, and recurranee rate and progression rate of tumor was 17.5 % （81/462） and 23.8 %（110/462）.The numbers （≥3） and the size （≥3 cm） and the location （close to vessels） of the lesions reduced the complete ablation rate. The numbers （≥3） of lesions affected the recurrence rate and progression rate of lesions as only risk factor. Recurrent hepatocellular carcinoma （HCC） and metstasis from gastrointestine or non-gastrointestine had higher recurrence rate and progression rate comparing with primary HCC.Conclusions RFA can effectively control local progression of hepatic maglinant tumors, and the tumor＇s size,number and location close to velssels could effect complete ablation rate, the number of tumors could effect the recurrence and porgression rate, Recurrent HCC and metstasis from gastrointestine or nongastrointestine had higher recurrence and progression rate comparing with primary HCC.