超声引导瘤内高温治疗肝细胞癌

Ultrasound guided hyperthermal ablation therapies for hepatocellular carcinoma

目的 探讨超声引导瘤内微波固化 (PMCT)和高温蒸馏水注射 (PHDI)两种疗法对不能切除肝细胞癌 (HCC)的应用价值。 方法 PMCT治疗 5 0例HCC共 10 7个结节 ,直径 (2 7± 1 5 )cm ,最大者 6 4cm。对不能施行PMCT的病例 ,创立了PHDI,治疗 47例HCC共 6 9个直径 (2 5± 0 5 6 )cm的结节。 结果 PMCT后CT检查 94 4%结节完全坏死。 1年、2年和 3年生存率分别为 96 6 %、83 2 %和 72 8%。局部复发率 5 6 %。PHDI后 81 2 %的结节完全坏死。 1年、2年和 3年生存率分别为 91 5 %、78 4%和 49 5 %。局部复发率 13 0 %。 结论 PMCT疗效较注射治疗稳定可靠 ,且突破了介入超声仅适用于小肝癌的局限 ,应用前景广阔。PHDI突出优点是副反应轻微和费用低廉 ,适用于肝功能较差、肿瘤与肝内重要结构相邻或其他治疗条件受限者。综合运用多种介入超声治疗手段以适应不同个体的需要 。

Objective[WT5”BZ] To evaluate the effect of percutaneous microwave coagulation therapy (PMCT) and percutaneous hot distilled water injection (PHDI) on hepatocellular carcinoma (HCC). [WT5”HZ]Methods[WT5”BZ] Fifty HCC patients with 107 tumor nodules were treated with PMCT. The diameter of the nodules ranged from 1 to 6 4 cm (average 2 7±1 5 cm). PHDI was performed for 47 patients with 69 nodules who were unsuitable for PMCT due to the tumors [average diameter (2 5±0 6) cm] located near larger vessel and liver capsule or poor liver functional reserve. [WT5”HZ]Results[WT5”BZ] For patients treated with PMCT, 94 4% of the nodules achieved complete necrosis judging by dynamic CT. Fine needle biopsy with multiple samples from different parts of the tumor was performed in 55 treated nodules and no viable tumor was detected in 52 (94 5%) of them. The 1 , 2 and 3 year survival rates were 96 6%, 83 2% and 72 8% respectively with a local recurrence rate of 5 6%. For patients treated with PHDI, 81 2% of the nodules showed complete necrosis and 77 8% of the 18 nodules that received biopsy showed no viable tumor cell. The 1 , 2 and 3 year survival rates were 91 5%, 78 4% and 49 5%. The local recurrence was 13 0%. [WT5”HZ]Conclusions[WT5”BZ] PMCT not only provides more reliable tumor ablation than injection therapies, but also extends its use to large HCC. PHDI is suitable for those with poor liver function, tumors beneath important intrahepatic structures or economic embarrassment. Using multiple interventional ultrasound modalities individually is beneficial to more patients with HCC. [WT5”HZ]