转换控制器介导的多电极同步射频消融治疗大肝癌的临床应用

Clinical application of multi-electrode synchronous radiofrequency ablation via switching controller for treating large hepatoceHular carcinoma

目的探讨转换控制器介导的多电极同步射频消融治疗大肝癌的初步临床疗效和安全性。方法回顾性分析中山大学肿瘤防治中心微创介入科2013年12月至2014年12月收治的20例大肝癌患者，以完全毁损肿瘤组织为目的，在CT引导下进行多电极同步射频消融治疗。根据第1次消融治疗后复查的影像学检查评估肿瘤坏死率，采用单因素方差分析对比消融前后总胆红素、白蛋白、肾功能、凝血功能等指标评估治疗安全性。结果20例患者共31个病灶，治疗后近期评价完全坏死率为51．6％（16／31），接近坏死率为22．6％（7／31），部分坏死率为9．7％（3／31），治疗有效率（坏死率〉50％）为83．9％。仅5例巨块型肝癌患者治疗后坏死率〈50％（16．1％）。治疗后未出现消融相关死亡病例。消融后患者总胆红素由（11．7±6．2）mg／L轻度上升至（19．2±12．0）mg／L，经护肝等对症处理后恢复消融前水平；消融前后肾功能及凝血功能比较，差异无统计学意义。5例次消融后患者出现不同程度发热（21．7％，5／23），6例次消融后呕吐（26．1％，6／23），仅3例次患者消融后3d内出现中重度疼痛（13．0％，3／23），采取口服止痛药后1周内均好转。结论转换控制器介导的多电极同步射频消融对大肝癌可获得较满意的治疗效果且安全性良好，为大肝癌的治疗提供了一种新的有效治疗模式。

Objective To explore the preliminary clinical efficacy and safety of multi-electrode synchronous radiofrequency ablation via switching controller for treating large hepatocellular carcinoma. Methods A total of 20 patients with large hepatocellular carcinoma from minimally invasive Interventional department of Sun Yat-sen University Cancer Center were enrolled in this retrospective study from December 2013 to December 2014. The procedures were conducted with multi-electrode synchronous radiofrequency ablation via switching controller under CT guidance. The necrosis rate of tumor was assessed by the following imaging examination. The single factor analysis of variance （ANOVA） was employed to compare the total bilirubin, albumin, renal function, blood coagulation function before and after ablation, to evaluate the safety of treatment. Result Twenty patients with a total of 31 lesions accepted 23 times ablation procedures using multi-electrode synchronous radiofrequency ablation via switching controller. The recent evaluation after treatment was as followed：complete necrosis rate 51.6% （ 16/31 ）, nearly complete necrosis rate 22. 6% （7/31）, partial necrosis rate 9.7% （3/31）, treatment effectiveness rate （ necrosis rate 〉 50% ） 83.9%. The necrosis rate which was less than half volume of the tumor was only seen in 5 cases with huge hepatocellular carcinoma （ 16. 1% ）. No dead cases appeared after ablation procedures. The patients＇ total bilirubin elevated moderately after ablation procedures and reversed to normal level after liver function protection treatment. There were no statistical differences of renal function and blood coagulation function before and after ablation. After ablation procedures, 5 cases （21.7%, 5/23） appeared fever, 6 cases （26. 1% ） with vomiting, only 3 cases （13.0% , 3/23 ） with moderately severe pain in 3 days after ablation and remitted after taking oral analgesics in one week. Conclusion The clinical efficacy of muhi-electrode synchronous radiofrequency ablation via switching controller for large hepatocellular carcinoma is satisfactory with guaranteed security, which can be a choice for treating large hepatocellular carcinoma.