超声引导下经皮微波消融较大肝癌治疗策略探索

Strategies of percutaneous microwave ablation in treatment of large hepatocellular carcinoma

目的探索较大肝癌经皮微波消融的治疗方案设计、布针原则、治疗效果及其并发症。方法 99例原发性肝癌(134个癌结节)经超声引导下行肿瘤微波消融治疗。根据瘤体大小、形态设计不同的治疗方案及布针原则。术后进行疗效的评估。结果本组病灶经超声引导下行肿瘤微波消融治疗后,4.1～5.0 cm、5.1～6.0 cm及>6 cm的肝癌完全消融率分别达到97.78%(44/45)、94.44%(34/36)、73.68%(14/19),总消融率94.03%(124/134);46个临近重要结构或大血管的病灶在超声引导下均穿刺布针成功,肿瘤完全消融率86.05%(37/43);微波消融后并发症的总发生率为21.21%(21/99),对症处理后均自然消失;病灶局部复发率为18.66%(25/134);远处再发率为15.15%(15/99);患者1、2、3、5年累计生存率分别为89.90%(89/99),71.83%(51/71),53.06%(26/49),28.57%(4/14)。结论采用"地毯式消融"、"防火带消融"策略以及"扩大消融范围的组合方案"治疗较大和邻近重要结构的肝癌是安全、有效、可行的。

Objective To evaluate the strategies of percutaneous microwave ablation in the treatment of large hepatocellular carcinoma, and the principle of needle arrangement, the treatment effect and its complications. Methods Ninely - nine patients with hepatocellular carcinoma （134 nodules） underwent microwave ablation treatment with guided by ultrasound . According to the size and the shape of lesions and their surrounding anatomic structures, different therapeutic plans and different needle distribution modes were applied,leading to relevant curative effects which were evaluated. Results Complete ablation rates were 97.78% （44/45） , 94.44% （34/36） , and 73.68% （14/19） in those nodules of 4.1 -5.0 cm, 5. 1 -6.0 cm, and 〉 6 cm respectively,with a total ablation rate of 94.03% （124/134）. Ultrasound - guided microwave ablation arangements were successful in 46 lessions neibouring to vital anatomic strutures, and the complete tumor ablation rate was 86.05% （37/43）. Total complication rate after microwave ablation was 21.21 （21/99） % , and after symptomatic treatment, all complications disappeared naturally. Local recurrence rate was 18.66% （25/134）, and distant recurrence rate was 15.15% （15/99）. 1,2, 3,5 year accumulative total survival rates were 89.90% （89/99） ,71.83% （51/71）, 53.06% （26/49） ,28.57% （4/14）, respectirely. Conclusion The conbined plan of carpet - mode ablation,fire wall ab- lation strategy and extending ablation range is safe, effective, and feasible, in treatment of large HCC neibouring to vital anatiomic structures.