超声引导下射频消融联合多极无水乙醇注射治疗直径3～7cm肝细胞癌

Combined ultrasound-guided radiofrequency ablation and ethanol injection with a multipronged needle for the treatment of hepatocellular carcinoma ranging from 3.0 to 7.0 cm in diameter

目的探讨超声引导下经皮射频消融联合多极无水乙醇注射治疗3cm以上肝细胞癌的有效性和安全性。方法对65例肝细胞癌患者的67个结节进行治疗，肿瘤直径3．1～7．0cm，术后观察疗效及并发症发生情况。结果首次治疗后结节的完全消融率为94．0％（63／67），4个残留的结节经补充治疗后均得到完全消融。主要并发症有3例，包括肝脓肿1例、腹腔出血1例、腹腔大量积液1例，经保守治疗后均好转。无治疗相关的死亡发生。术后平均随访（20．0±7．6）个月（6．7～32．6个月），肿瘤局部进展10例，远处复发32例。共有57例患者存活，8例死亡。1年、2年累积生存率分别为93．1％及88．1％。结论射频消融联合多极无水乙醇注射能够安全、有效地治疗直径3em以上，尤其是3～5cm的肝细胞癌。

Objective To evaluate the therapeutic efficacy and safety of radioffequency ablation （RFA） combined with ethanol injection with a multipronged needle under ultrasound guidance for the treatment of hepatocellular carcinoma （HCC） larger than 3 cm in diameter. Methods 65 patients with 67 HCC nodules ranging from 3.1 to 7.0 cm in diameter were treated percutaneously under ultrasound guidance. Tumor response and complications after treatment were observed. Results Complete ablation was achieved in 94.0% （63/67） of HCC nodules. 4 residual tumor nodules received complete ablation after additional treatment. Ablation-related major complications was occurred in 3 patients,including liver abscess in 1 case,abdominal bleeding in 1 case and massive ascites in 1 case,all were cured by conservative therapy. After a mean follow-up period of （20.0 ± 7.6） months （6.7 - 32.6 months） ,local-tumor progression was observed in 10 （14.9%） of 67 HCC nodules, and distant recurrence was observed in 32 （49.2%） of 65 patients. The 1-year and 2-year survival rate were 93.1% and 88.1%, respectively. Conclusions RFA combined with ethanol injetion with a multipronged needle is a safe and effective technique for the treatment of hepatocellular carcinoma larger than 3 cm,especially 3 - 5 cm in diameter.