CT引导射频消融治疗膈顶部肝癌的临床研究

Clinical investigation of CT-guided radiofrequency ablation for liver cancer in hepatic dome area

目的:探讨经肝而非经肺的CT引导射频消融(CT-guided radiofrequency ablation,CT-RFA)治疗膈项部肝脏恶性肿瘤的技术路线、临床疗效和安全性。方法:对2003年9月-2012年10月本科收治的50例原发性或转移性肝癌患者的59个膈顶病灶进行CT-RFA治疗的临床资料进行回顾性分析。分析和总结CT-RFA治疗膈顶部肝脏恶性肿瘤的技术路线,并观察疗效和安全性。结果:本研究应用"立方体"模型,建立三维定向CT-RFA治疗膈顶部肝癌的穿刺路径。59个膈顶病灶的RFA治疗成功率和完全消融率分别为94.92%(56/59)和84.75%(50/59)。完全消融病灶患者的中位局部无复发时间为12.05个月,其中原发性肝癌患者为14.23个月,转移性肝癌患者为8.07个月,差异有统计学意义(P=0.037)。3例患者在RFA术后发生严重并发症,经对症治疗后好转。多因素分析结果显示,病灶大小是局部无复发生存时间的独立相关因素(P=0.028)。结论:经肝而非经肺的CT-RFA治疗膈顶部肝癌是一种安全而有效的治疗方法。肿瘤大小是局部无复发生存时间的独立相关因素。

Objective： To investigate the technical procedure, clinical efficacy and safety of extrathoracic and transhepatic CT-guided radiofrequency ablation （CT-RFA） for liver cancer in hepatic dome area. Methods： A retrospective analysis was conducted in 50 patients who were diagnosed of primary liver cancer or metastatic liver cancer and received CT-RFA between September 2003 and October 2012. The total number of the malignant lesions in the hepatic dome area were 59. The detailed technical procedure, clinical efficacy and the safety as well as the factors related to local recurrence- free survival were anaylized and summarized. Results： The pathway for needle puncture of RT-RFA in treatment of the malignant lesions in the hepatic dome area was established by using a new ＂cube＂ model. The rates of technical success in RFA and complete necrosis were 94.92% （56/59） and 84.75% （50/59）, respectively. The median local recurrence-free survival time of patients with completely necrotic lesions was 12.05 months, which for primary liver cancer and metastatic liver cancer were 14.23 and 8.07 months, respectively （P = 0.037）. Three patients developed severe complications after RFA, and recovered after supportive treatment. The multivariable analysis revealed that the tumor size was an independent factor related to the local recurrence-free survival （P = 0.028）. Conclusion： CT-RFA for the treatment of malignant lesions in the hepatic dome area is safe and effective. The tumor size is an independent risk factor related to the local recurrence-free survival.