微波消融同步联合TACE治疗大肝癌和巨块型肝癌的临床疗效分析

Microwave ablation combined with simultaneous transarterial chemoembolization for the treatment of large and massive hepatocellular carcinoma

目的评价微波消融（microwave ablation,MWA）同步联合经动脉化疗栓塞（transarterial chemoembolization,TACE）治疗大肝癌（直径〉5 cm）和巨块型肝癌（直径〉10 cm）的安全性和有效性。方法回顾性分析2013年3月至2014年12月期间在复旦大学附属中山医院行经皮MWA同步联合TACE治疗的65例大肝癌或巨块型肝癌患者（肿瘤直径5~18 cm）,治疗程序为先行动脉数字减影血管造影（digital subtraction angiography,DSA）,接着超声引导下行经皮MWA,最后行再次血管造影并选择TACE治疗。结果同步治疗耐受性好。造影剂外渗3例,经栓塞后消失。术后仅见轻微肝功能受损和血液毒性及少量的胸腔积液,未见脓肿、胆道损伤、肝功能衰竭及其他手术相关的严重并发症。TACE碘油栓塞剂用量平均为8 mL。随访2~21个月,65例患者无疾病进展生存时间为（6.3±1.5）个月,中位生存时间为14个月,6、12及18个月的生存率分别为91.3%、81.5%及48%。2例患者获得II期手术切除。结论 MWA联合同步TACE治疗大肝癌和巨块型肝癌安全、有效,既可扩大消融的适应证,又能减少TACE栓塞剂的用量,是值得推广的肝癌治疗新模式。

Objective To assess the safety and efficacy of microwave ablation（MWA）combined with simultaneous transarterial chemoembolization（TACE）for large（diameter〉5 cm）and massive（diameter〉10 cm）hepatocellular carcinoma（HCC）. Methods We reviewed the records of 65 patients with large or massive HCC treated with ultrasound-guided percutaneous MWA with simultaneous TACE between March 2013 and December 2014.The treatment procedure consisted of：initiative digital subtraction angiography（DSA）,followed percutaneous MWA under ultrasound and subsequential angiography plus TACE. Results The combination therapy was well tolerated in all patients with transitory hepatic and hematological toxicity and asymptomatic pleural effusion.Contrast agent extravasation was detected in 3 patients and dealt with embolization in time.There was no liver abscess,bile duct injury and other procedure related major complications.The average dosages of lipiodol were 8 mL.During the follow-up period（range 2-21 months）,the mean progression-free survival time was（6.3±1.5）months.The median survival time was14 months.The 6-,12-and 18-month overall survival rates were 91.3%,81.5%and 48%,respectively.Two patients underwent Ⅱ-stage surgical resection after immediate combination therapy. Conclusions MWA combined simultaneous TACE therapy can be performed safely and effectively in patients without major complications for large and massive HCC.It enlarged the indications of MWA,and was worth to be promoted.