B超引导下经皮端冷射频治疗不可切除肝癌

The Treatment of Unresectable Hepatocellular Carcinoma by Radiofrequency Ablation under Ultrasound Guidance

目的 :评价端冷射频消融在 HCC治疗中的作用。方法 :13例患者均为男性 ,HBV(+) ,平均年龄 5 2 .3岁 ,Child's分级 A级 11例 ,B级 2例 ,无门静脉癌栓及肝外转移 ,肿瘤总数为 2 1个 ,其中直径 >3cm 7个 ,<3cm 14个 ,平均为3.6 cm,范围 1.8～ 10 .8cm,共穿刺 35次。RFA治疗前患者肌注度冷丁 5 0 mg,穿刺部位局部浸润麻醉 ,将端冷电极或集束电极在 B超引导下穿刺 ,直接到达肿瘤 ,同时端冷系统开始灌注 3～ 5℃冷凝生理盐水以保证 RFA治疗过程中电极端的持续冷却。 RFA治疗后 2周 B超检查 ,有条件者行螺旋 CT检查 ,以判断 RFA的治疗效果。结果 :13例患者RFA治疗后无术后死亡及并发症。以 12 0 0 m A,每次 12 min RFA治疗后 ,经 B超检查 ,肿瘤结节小于 3cm的 14个中有11个完全坏死 ,占 79% ,在直径大于 3cm的 7个肿瘤结节中有 3个经螺旋 CT检查完全坏死 ,占 43%。结论 :端冷射频消融治疗不可切除肝癌是一个安全有效的方法 ,特别是在肿瘤小于 3cm时 。

Objective:To evaluate the effect of radiofrequency ablation using a newly developed 'cooled tip' electrode in the treatment of hepatocellular carcinoma Methods:Thirteen patients (meanage 52.3 yrs.All men,all of HBV positive;ll in Child's Class A and 2 in Child's Class B)with HCC rising from cirrhosis with 21 tumor nodules (mean diameter.3 6 cm;range:1 8~10 8cm;7 diameter>3 cm) have been treated by RFA with 'cooled tip'electrode in our department.None of the patients had portal vein tumor thrombi and/or extra hepatic spread.A radiofrequency generator connected to 18 gauge perfusion electrode with an exposed tip of 2~3cm was used.Before the procedure,patient has a local anesthesia after a muscle injection of 50mg of Meperidine.The electrode was placed directly into the tumor nodule under ultrasound (US) guidance.Meanwhile,the cool tip system infuse a chilled saline solution to guarantee the continuous cooling of the needle tip.B type US in 13 of the patients and helical CT in 4 was carried out respectively 2 weeks or a month after RFA to assess treateent efficacy.Results:No mortality and morbidity occurred.IN all 35 of thermal injures (at 1200 mA for 12 min)were caused in the 21 tumor nodules.Complete necrosis as assessed at B type US in 11 of 14 nodules (79%) (Diameter<3 cm) compare with at helical CT in 3 of 7(43%)(Diameter>3cm) was achieved.Conclusion:RFA with the 'cooled tip' electrode could provide effective and safe palliative treatment of patients with unresectable HCC,especially working as the diameter of tumor nodule ness than 3 cm,and shorten the hospital staying.