肝动脉化疗栓塞联合射频消融治疗包膜下肝癌的疗效和安全性

Carcinoma, hepatocelluar; Radiology, interventional; Embolization, therapeutic; Ablation techniquesClinical efficacy and safety of transcatheter arterial chemoembolization combined with radiofrequency ablation for hepatocellular carcinoma under liver capsular

目的探讨肝动脉化疗栓塞（TACE）联合射频消融术（RFA）治疗包膜下肝癌的安全性和疗效。方法回顾性分析采用TACE联合RFA治疗的包膜下肝癌患者43例（62个病灶）。患者均先行TACE治疗，1～2周后行CT引导下RFA治疗。术后观察患者不良反应，并随访复查MRI判断疗效，对残留病灶在1周内行第二次RFA治疗，对随访中发现复发及新发病灶则再次行TACE联合RFA治疗。采用Kaplan．Meier生存曲线计算生存率、中位生存期及中位疾病进展时间。结果43例患者（62个病灶）共行TACE治疗55次，CT引导下经皮射频消融治疗68次。首次RFA后肿瘤病灶完全坏死率为90．3％（56~2），对残留病灶二次RFA后的肿瘤病灶完全坏死率为98．3％（61／62）。43例患者的治疗完全缓解率为93．0％（40／43）。治疗后1、3、5年生存率分别为95．3％、78．1％、43．9％，中位生存期为58个月，中位疾病进展时间是32个月。结论TACE联合RFA治疗包膜下肝癌安全、有效。

Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） in treating hepatocellular carcinoma （HCC） under liver capsular. Methods Forty three patients with 62 lesions of HCC under liver capsular received TACE followed by CT-guided percutaneous RFA after 1 to 2 weeks were analyzed retrospectively. The subjects were observed and follow-up imaging with enhanced MRI was performed to evaluate the therapeutic efficacy after combined treatment. The patients were followed up for 10 to 69 months. The patients with residual lesions received a second RFA, the patients with recurrence or new lesions received another TACE combined with RFA. The overall survival rates, median survival time and median time to progression were calculated by using Kaplan-Meier. Results A total of 55 TACE and 68 ablations were performed in 43 patients with 62 lesions. The procedure was successfully accomplished in all patients. The complete ablation rate after the first ablation was 90.3% （56/62）. The 1, 3, 5- year overall survival rates were 95.3%, 78.1% and 43.9%, the median survival time was 58 months and the median time to progression was 32 months. Condution For the treatment of hepatocellular carcinoma under liver capsular, TACE combined with RFA is safe and effective.