超声引导射频消融治疗肝脏恶性肿瘤

Ultrasound-guided radiofrequency ablation of malignant hepatic tumors

目的 探讨超声引导射频消融 (RFA)对肝脏恶性肿瘤的治疗效果。方法 对原发性肝癌 5 5例、肝转移癌 37例 ,计 92例、132个病灶行超声引导RFA治疗 ;肿瘤大小中位数为 3 .2cm(1.5～ 8.0cm)。89例经皮超声引导RFA术均在门诊进行 ,余 3例行术中超声引导下RFA治疗。采用螺旋CT增强检查及其他方法综合评价疗效。结果 1d或 1个月后增强CT检查 ,显示 12 0个病灶被完全灭活 ,有效率达90 .9% ,其中有 2 1例 (2 2 .8% )行第 2～ 4次RFA治疗。 1至 3个月后CT显示 85例 (6 8.5 % )肿瘤缩小。1例巨块型肝癌大出血 ,急诊手术中行RFA治疗止血成功。经 3～ 16个月随访 ,目前 89例存活 ,1例因手术、2例因合并食管静脉瘤出血死亡。较重并发症 3例 ,1例损伤肝被膜致出血 ,经RFA止血成功 ;1例肝功能指标异常加重 ,出现黄疸、腹水 ;另 1例肝管显著扩张 ,黄疸加重 ,行经皮肝胆管置管引流。结论 超声引导RFA对不能或不适宜手术切除的肝脏恶性肿瘤提供了有效的微创治疗手段 ,但选择适应证及重视操作方法仍是关键因素。

Objective To evaluate the efficacy of ultrasound guided radiofrequency ablation (RFA) in primary and secondary hepatic cancers.Methods Ninety two patients with 132 tumors were treated with RFA from December 1999 to January 2001. Of these, 55 cases were primary liver cancer and 37 cases were hepatic metastases. The median of lesion size was 3.2 cm ( 1.5 ～ 8.0 cm). Three patients were treated intraoperatively and the others were treated percutaneously in clinic. All patients were followed up using contrast enhanced CT postoperatively.Results One hundred and twenty lesions were completely ablated according to contrast enhanced CT. Thus, the total response was 90.9 %(120/132). Among these patients, 21 cases ( 22.8 %) were treated with RFA 2～4 times. In 3 months after RFA, most lesions were demonstrated a progressive decrease in size. The massive bleeding of an enormous liver cancer with spontaneous rupture was stopped successfully by RFA during emergent operation.Of patients followed up for 3～16 months,89 were alive, 3 died due to other causes.The significant treatment related complications occurred in 3 of the 92 patients ( 3.2 %), including one hemorrhage stopped by RFA, one liver incompetence and one temporary dilatation of hepatic duct. Conclusions Ultrasound guided RFA seems to be an effective minimally invasive treatment technique for patients with malignant hepatic tumor. It's also very important to perform RFA in a proper technique and select indications for treatment. RFA seems to be an option to treat hemorrhage of patients with ruptured hepatic tumors.