肝动脉化疗栓塞和即时射频消融术治疗膈下巨大肝细胞癌临床研究

PRELIMINARY STUDY OF COMBINATION TRANSCATHETER ARTERIAL CHEMOEMBOLIZATION AND FLUOROSCOPY-GUIDED PERCUTANEOUS RADIOFREQUENCY ABLATION FOR HUGE HEPATOCELLULAR CARCINOMA

目的 评估DSA引导下联合TACE和即时射频消融技术治疗膈顶巨大肝癌的安全性和初步疗效。方法 该项回顾性研究得到解放军总医院伦理委员会的批准、所有患者均签署知情同意书。2010年1月—2011年9月共8例巨大肝细胞癌患者,共8个病灶。所有病灶均位于累及右侧膈下、肝顶,平均最大直径12.5cm（10.0~13.5cm）。采用的策略是：常规进行1~2次超选择肝动脉化疗栓塞,1个月后采用残留病灶,采用DSA引导下TACE联合全麻下即时射频消融技术,重点消融碘油沉积残留病灶。术后评估技术成功率、技术相关并发症和局部肿瘤治疗反应。定期影像学评估,随访过程中患者肿瘤进展情况和患者存活情况。结果 技术成功率100%,所有患者均未发生重要并发症。联合治疗1个月后复查,CR7例、PR1例、PD0例。7例CR患者中位至疾病进展期（TTP）为9个月（4~18个月）。随访过程中[（中位随访时间14个月（3~19个月）],所有患者均存活。结论 DSA引导下联合TACE和即时射频消融治疗膈下巨大肝癌安全、有效。

Objective To assess the technical safety and efficacy of fluoroscopy(DSA)-guided percutaneous radiofrequency(RF)ablation combined with transcatheter arterial chemoembolisation(TACE)for huge hepatocellular carcinoma(HCC).Methods Our retrospective study was approved by the institutional review board of PLA general hospital and informed consent was waived.eight patients with eight subphrenic huge HCCs(mean max diameter 12.5 cm;range 10.0~13.5cm)were treated with percutaneous RF ablation combined with TACE between January 2010 and September 2011.Our strategy for huge HCC was:first we do routine super-TACE,1 month later we do combination TACE)and simultaneously fluoroscopy-guided percutaneous radiofrequency(RF)ablation under general anesthesia.Major complications,rate of technical success,local-regional tumor response and survival were evaluated at follow-up images.Results Technical success was achieved for all eight visible HCCs.Major complication was not observed in any patient.Seven patients were CR(complete response),1 was PR(partial response)and non PD(progressive disease)after the first months of combinarion TACE and RF ablation.During follow-up period(median14 months;range 3~19 months),all patients were survival,Median TTP(time to progress)was 9 months(4~18months)in seven patients with CR.Conclusion Simultaneous and real-time fluoroscopy(DSA)-guided RF ablation combined with TACE is safe and effective for treatment of huge HCC.