经皮射频毁损治疗肝脏肿瘤的近期疗效观察

Early Effects of Percutaneous Radio-frequency Ablation for Treatment of Liver Tumors

目的:观察经皮射频毁损治疗肝脏肿瘤的近期疗效,探讨其最佳适应证和治疗相关因素。方法:应用RF2000型射频治疗仪、LeVeen多弹头射频电极,超声引导下经皮穿刺毁损,对60例肝脏肿瘤患者(87个肿瘤)进行了72次治疗,分别观察其毁损范围、AFP水平、肝功能反应、并发症等。结果:原发性肝癌肿瘤直径小于5cm者1次性完全毁损61.11%(11/18),3例2次治疗1例完全毁损;肿瘤直径5～10cm者31例2例1次性完全毁损(6.45%),其余均大部或部分毁损,2次治疗6例毁损范围扩大,均未完全毁损;直径大于10cm者11例1次治疗仅部分毁损,2次治疗2例仍有较大肿瘤组织残余。转移癌均为多发,肿瘤结节2～8个不等,1次治疗均未完全毁损,1例2次治疗效果不明显。术后复查,38例原发性肝癌(PHC)AFP升高者,15例AFP明显降低(39.47%),肿瘤直径小于5cm者AFP下降率为76.92%(10/13),5例完全阴转(38.46%)。所有患者均出现轻度的肝功能损害;并发自限性腹腔出血2例,胆漏、气胸各1例;3例肝硬化明显、且毁损范围较大者并发中、少量腹水,内科治疗均恢复。结论:经皮射频毁损治疗肝脏肿瘤是一安全有效的治疗方法,直径小于5cm的PHC或转移癌多可完全毁损,直径大于5cm者分次治疗,能明显减小肿瘤体积。

Objective:To observe the early effects of percutaneous radio-frequency(RF)therapy on ablation of liver tumors and study its relative factors with the treatment.Methods:Sixty patients with liver tumors(87tumors)were treated72times by using RF2000type device and Le Veen multi-pole RF electrode.The ablation area,serum AFP,liver functions and com-plications were observed after RF ablation.Results:The one-time complete ablation rate of patient with primary hepatocellular carcinoma (PHC)of<5cm,5-10cm and>10cm in diameter were61.11%,6.54%and0%respectively.Only one case was fully ablated in12cases after second treatment,and the necrosis area enlarged but tumor reduced in others.All7metastatic cases had partial necrosis.After treatment,the high-AFP declined in15of38cases of PHC(39.47%),but in10of13patients,the decline rate of AFP in patient with tumor size<5cm was76.92%and in5cases,the AFP turned to negative(38.46%).Mild liver functional damage ap-peared in all patients under treatment.One major complication(biliary peritonitis required drainage)and6minor complications(2intraperitoneal bleeding,1pneumothorax and3ascites)occurred in patients with RF ablation.Conclusion:Percutaneous radio-frequency ablation for treatment of liver tumors is a safe and effective technique.Tumors of<5cm in diameter canmostly get complete ablation and repeat treatment can significantly reduce the size of tumor of<5cm.