超声引导射频消融术应用于治疗肝转移癌

Ultrasound-guided radiofrequency ablation in the treatment of liver metastases

目的 :探讨超声引导射频消融对肝转移癌的治疗效果及临床应用价值。方法 :对不宜手术、放疗、化疗或不愿接受手术治疗的肝转移癌患者 48例 (91个灶 )行超声引导下射频治疗。原发灶来自消化道肿瘤 33例(6 8.7% ) ,乳腺癌 7例 (14.5 % ) ,其他肿瘤 8例 (16 .8% )。本组肿瘤最大直径范围为 1.5～ 7.2cm (中位数 2 .3cm) ,2 6例为单发灶 ,余 2 2例为 2～ 5个病灶。采用螺旋CT增强扫描为主结合彩超、穿刺活检、肿瘤标记物等检查方法综合评价疗效。结果 :1个月后螺旋CT增强扫描显示 87个病灶完全失去活性 ,近期有效率达 95 .6 %。有 4例局部复发 ,14例肝内其他部位再发 ,而行第 2～ 4次治疗。全部病例经 3～ 18个月随访 ,目前 46例存活 ,2例射频后肿瘤缩小者行手术治疗 ,因手术并发症死亡。较重并发症 1例 (2 .1% )为肝被膜损伤出血 ,经射频消融凝固止血成功。结论 :超声引导射频消融术可作为肝转移癌的一种微创局部治疗方法 ,其并发症少 ,缓解率高 ,是治疗肝转移癌安全。

Objective: To study the efficacy and the clinical value of ultrasound guided radiofrequency ablation(RFA) in the treatment of liver metastases. Methods: 48 patients (91 liver metastatic lesions), who were neither appropriate candidates for resection, chemotherapy and radiotherapy nor willing to undergo resection, were treated with RFA. There were 33 gastrointestinal metastases (68.7%) , 7 breast metastases(14.5%) and 8 other metastases(16.8%). The maximum lesion sizes ranged from 1.5-7.2 cm(mean, 2.3 cm). 26 patients had single tumor lesion, the remaining 22 patients had multiple lesions. The therapeutic response was assessed after treatment by contrast enhanced spiral CT primarily, color ultrasound, biopsy and tumor marker. Results: 87 lesions were completely ablated according to the results of contrast enhanced spiral CT 1 month after the RFA(response rate, 95.6%). There were 4 patients with local recurrence, and 14 patients with multi focal recurrences in the liver, who were all treated with other 2-4 RFAs. In a follow up program of 3-18 months, 46 patients were alive to date, and 2 died of surgical complications and other diseases. A serious complication of bleeding due to the trauma of liver membrane occurred in one patient (2.1%), but the hemorrhage was successfully coagulated and stopped by immediate RFA. Conclusion: Ultrasound guided RFA seems to be an effective and minimally invasive technique for the local treatment of liver metastases. It could be performed for several times on those recurrent lesions in a short period of time during the follow up program. The RFA is a safe treatment with low complication rate.