三维重建在提高肝癌第一次射频消融治疗成功率的应用价值

Three-dimensional reconstruction to improve the success rate in the first attempt of radiofrequency ablation for small hepatocellular carcinoma

目的探讨三维重建在提高肝癌第一次射频消融治疗成功率的应用价值。方法选取2010年6月至2013年6月广州医科大学附属肿瘤医院收治的、直径3～5cm的单发小肝癌患者109例。所有患者均接受射频消融治疗。其中术前行三维重建49例患者作为三维组，术前未经三维重建60例患者作为二维组。比较两组患者一次彻底消融率、生存率及并发症。结果二维组一次彻底消融率为48．3％（29／60），局部复发率为23．3％（14／60）；三维组一次彻底消融率达95．9％（47／49），局部复发率为8．1％（4／49）。三维重建组一次彻底消融率明显高于二维组，局部复发率明显低于二维组，差异均具统计学意义（P〈0．05）。三维组患者1、2、3年无复发生存率分别为85．4％、63．9％和49．8％，二维组患者1、2、3年无复发生存率分别为72．4％、43％和34．4％。三维组患者术后3年无复发生存率显著低于二维组，两者差异有统计学意义（P〈0．05）。三维组患者1、2、3年总体生存率分别为91．4％、78．4％和60．9％，二维组患者1、2、3年总体生存率分别为83．3％、58．7％和40．9％。三维组患者术后3年总体生存率优于二维组患者，差异具有统计学意义（P〈0．05）。三维组术后并发症（4％，2／49）较二维组（13．3％，8／60）明显减少，差异具有统计学意义（P〈0．05）。结论术前三维重建可提高患者一次彻底消融率，可显著改善患者预后，减少并发症，对于3-5cm大小的肿瘤射频消融具有重要的应用价值。

Objective To evaluate the use of three-dimensional reconstruction （3D） to improve the success rate in the first attempt of radiofrequency ablation （RFA） for small hepatoeellular carcinoma （HCC）. Methods A retrospective study was conducted on 109 patients with small HCC （with single no- dule from 3 to 5 cm in diameter） treated with radiofrequency ablation between June 2010 and June 2013. A safe ablation margin was evaluated before and after radiofrequency ablation. The patients were divided into two groups： the 3D-RFA group （49 patients were evaluated by three-dimensional reconstruction before RFA treatment） and the 2D-RFA group （60 patients were not evaluated by three-dimensional reconstruction before RFA treatment）. The success rate of the first attempt of radiofrequency ablation, recurrence free survival, o- verall survival and complications were compared between the two groups. Results The success rate of first ablation reached 95.9% （47/49） in the 3D-RFA group which was significantly higher than the 48.3% （29/60） in the 2D-RFA group （P 〈0. 05）. The local tumor progression rate was 8.1% in the 3D-RFA group versus 23.3% in the 2D-RFA group （P 〈0. 05）. The 1-, 2-, 3-year recurrence free survival rates were 85.4% , 63.9% , and 49. 8% respectively in the 3D-RFA group and 72.4% , 43% , and 34.4% re- spectively in the 2D-RFA group （ P 〈 0. 05 ）. The 1-, 2-, 3-year overall survival rates were 91.4% , 78.4%, and 60. 9% respectively in the 3D-RFA group and 83.3% , 58. 7%, and 40. 9% respectively in the 2D-RFA group （P 〈 0.05 ）. Complications occurred significantly less in the 3D-RFA group （4%, 2/ 49） than the 2D-RFA group （ 13.3% , 8/60 ; P 〈 0.05 ）. Conclusion Three-dimensional reconstruction improved the success rate of the first attempt of radiofrequency ablation and the prognosis of patients, and with less complications for small hepatocellular carcinoma.