超声引导经皮微波治疗原发性肝癌远期疗效评价

Ultrasound-guided percutaneous microwave coagulation therapy for primary hepatocellular carcinoma

目的 评价经皮穿刺微波凝固治疗 (PMCT)原发性肝癌 (HCC)的远期疗效。方法 在超声引导下对 177例HCC患者共 2 6 5个肿瘤灶进行PMCT ,病灶最大直径 1.5～ 8.7cm ,平均4.12± 1.89cm。随访 5～ 74个月 ,定期复查影像 (彩超、CT、MRI)及血清AFP ,184个结节再次穿刺活检。结果 治疗后超声检查显示 ,92 .0 % (2 0 7/ 2 2 5 )的病灶血流消失 ,88.5 % (138/ 15 6 )的病灶增强CT无强化 ,88.9% (32 / 36 )的病灶增强MRI无强化。 184个结节治疗后再活检 ,92 .4% (170 / 184)完全坏死。 6例患者PMCT后外科切除病灶 ,病理显示肿瘤完全坏死 5例 ,大部分坏死 1例。全组 1～ 5年累计生存率分别为 90 .1%、76 .9%、6 8.3%、6 4.2 %和 5 7.8% ,高分化及中分化者的生存曲线均明显好于低分化者 (P <0 .0 5 ) ,中分化与高分化者之间无统计学差异。全组 1～ 5年累计新生病灶率分别为2 6 .1%、37.8%、43.5 %、48.6 %和 5 8.9%。全组无严重并发症。结论 PMCT治疗HCC安全有效 ,可使直径 <5cm的肿块一次原位灭活 ,患者的 5年生存率较高。

Objective To evaluate the long-term results of percutaneous microwave coagulation therapy (PMCT) for primary hepatocellular carcinoma. Methods From May 1994 to May 2000, 177 hepatocellular carcinoma patients with 265 nodules underwent PMCT with ultrasound(US) guidance. The tumor size varied from 1.5 to 8.7 cm (median 4.12+1.9 cm). Follow-up examination was carried out with colour US, CT, MRI and AFP. 184 nodules were re-biopsied during the follow up of 5-74 months (median 29 months). Results After PMCT, colour Doppler flow signals disappeared in 92.0%(207/225) of patients. No enhancement was observed in 88.5%(138/156) by CT and 88.9%(32/36) by MRI. Re-biopsy of 184 nodules showed complete necrosis in 92.4%(170/184). Six resected lesions showed complete tumor necrosis in 5 and subtotal necrosis in 1. The 1- to 5-year survival rates were 90.1%, 76.9%, 68.3%, 64.2% and 57.8%, respectively. The survival rates of the well differentiated lesions were better than those of the poorly ones ( P <0.05). But there was not statistical significance between the moderately and the well differentiated ones. The new lesions development rates in 1 to 5 years were 26.1%, 37.8%, 43.5%, 48.6% and 58.9%, respectively. However, there was no severe complication.Conclusion Ultrasound-guided microwave coagulation is safe and effective for primary hepatocellular carcinoma. It can eliminate tumors less than 5 cm in diameter.