超声引导经皮射频消融对邻近横膈部原发性肝癌治疗的有效性与安全性评价

Clinical study of ultrasound-guided percutaneous radiofrequency ablation for primary hepatic carcinoma adjacent to the diaphragm

目的探讨超声引导下经皮射频消融治疗邻近横膈部原发性肝癌的安全性及有效性。方法收集2011年1月至2014年10月解放军三○二医院行超声引导经皮射频消融治疗的患者277例,共计362个原发性肝癌病灶,根据入组标准选择其中66例(共71个邻近横膈部病灶)作为研究组,95例(共114个位于肝实质病灶)作为对照组。比较两组患者病灶治疗术后肿瘤灭活率、局部肿瘤进展发生率和并发症发生情况。计量资料两组间比较采用独立样本t检验,计数资料两组间比较采用χ2检验。结果术后1个月,增强CT或磁共振成像显示研究组65个病灶(91.5%)及对照组107个病灶(93.9%)完全灭活,两组比较差异无统计学意义(χ2=0.36,P=0.55);随访术后研究组与对照组发生局部肿瘤进展的病灶分别为16.9%、13.2%,两组比较差异无统计学意义(χ2=0.49,P=0.48)。研究组术后有22例患者出现副反应,对照组有37例患者出现副反应,两组比较差异无统计学意义(χ2=2.60,P=0.11)。结论超声引导经皮射频消融治疗膈顶部肝肿瘤是安全、有效的。

Objective To investigate the safety and efficacy of ultrasound （US）-guided percutaneous radiofrequency ablation （RFA）for primary hepatic carcinoma adjacent to the diaphragm.Methods This study included 277 patients with 362 lesions of primary hepatic carci-noma managed with US-guided percutaneous RFA in 302 Hospital of PLA from January 2011 to October 2014.Sixty-six patients with 71 hepatocellular carcinomas （HCCs）located less than 5 mm from the diaphragm were in study group,and 95 patients with 1 14 HCCs located more than 10 mm from the hepatic surface were in control group.The patients′symptoms and complications were observed after the therapy. The complete ablation rate,local tumor progression rate,and complication rate were compared between the two groups.Comparison of con-tinuous data between the two groups was made by independent-samples t test,while comparison of categorical data was made by chi -square test.Results At one month after operation,65 （91.5%）of 71 tumors in the study group and 107 （93.9%）of 114 tumors in the control group achieved complete ablation,according to contrast-enhanced CT and MRI,and there was no significant difference between the two groups （χ2 =0.36,P=0.55）.The postoperative follow-up showed that the local tumor progression rates in the study group and con-trol group were 16.9% and 13.2%,respectively,without significant difference between the two groups （χ2 =0.49,P=0.48）.In the study group,22 patients developed adverse reactions,versus 37 patients in the control group （χ2 =2.60,P=0.1 1 ）.Conclusion US-guided percutaneous RFA is a safe and effective means for the treatment of primary hepatic carcinoma adjacent to the diaphragm.