经皮穿刺选择性门静脉栓塞术对增强肝恶性肿瘤射频消融作用的初步研究

Primary experience of improving effectiveness of radiorequency ablation for liver tumor by selective portal vein embolization

目的探讨经皮选择性门静脉栓塞术（SPVE）对提高冷循环射频消融（RFA）治疗直径〉3cm肝恶性肿瘤的疗效及安全性。方法对拟行射频消融的肝恶性肿瘤中为单发病灶，最大径〉3cm且结节完全或大部分位于一个肝段内的患者63例，以1：2配对方式随机表法随机人组，21例射频治疗前先行门静脉栓塞术（SPVE＋RFA组），42例患者单纯行射频消融治疗（RFA组），对比分析两组患者术后并发症发生情况、肿瘤消融效果。结果SPVE＋RFA组中1例SPVE操作失败，其余均操作成功，两组均未发生严重并发症。术后平均随访14．2个月，RFA组术后的局部残留复发率为40．5％（17／42），而SPVE＋RFA组的局部残留复发率为15．0％（3／20），两组差异有统计学意义（P=0．043）。结论SPVE能安全有效地增加单一肝段内〉3cm肿瘤RFA的疗效。

Objective To explore the feasibility and efficacy of the selective portal vein embolization （SPVE） before radiofrequency ablation（RFA） for liver tumor large than 3 cm. Methods 63 patients with 63 liver tumor （~3 cm） located in single liver segment completely or mostly underwent RFA. 21 patients （21 lesions） were randomly assigned to receive SPVE before ablation（SPVE ＋ RFA group）, other 42 patients were treated with RFA only （RFA group）. The complications and treat results of two groups were collected and compared. Results SPVE were achieved in 20 of 21 patients,and no critical complication were happened in both group. During a observation period of median 14.2 months,local tumor progression were observed in 17 of 42 patients （40.50//oo） in RFA group and in 3 of 20 patients （15.0%） in SPVE ＋ RFA group,there were significant difference between two groups（ P = 0. 043）. Conclusions SPVE can safely and effectively improve the efficacy of RFA for the liver tumors which large than 3 cm and located in single liver segment.