肝动脉化疗栓塞术后行经皮射频消融术治疗高危部位原发性肝癌的效果和安全性分析

Clinical effect and safety of percutaneous radiofrequency ablation following transcatheter arterial chemoembolization in treatment of primary liver cancer in high-risk locations

目的探讨在肝动脉化疗栓塞术（TACE）基础上行经皮射频消融术（RFA）治疗高危部位肝癌病灶的临床疗效及安全性。方法收集2011年1月-2015年12月首都医科大学附属北京地坛医院收治的高危部位原发性肝癌患者64例。所有患者首先行TACE治疗,术后3~5 d行RFA治疗。RFA治疗均在CT引导下完成。主要观察治疗效果及不良反应发生情况。结果 64例患者中共包含76个病灶,均完成TACE及RFA治疗。术后1个月肿瘤完全消融率为81.5%（62/76）。术后随访6~64个月,至随访结束,肿瘤局部进展率为28.9%（22/76）;1、2、3年生存率分别为90.6%、78.1%、64.1%。随访期间手术严重并发症发生率为3.1%（1例出现肝脓肿、1例出现胆道出血）,分别在内科治疗和介入治疗后缓解且无后遗症。结论在TACE基础上行CT引导下经皮RFA治疗高危部位原发性肝癌是一种安全可行的治疗方案。

Objective To investigate the clinical effect and safety of percutaneous radiofrequency ablation（ RFA） following transcatheter arterial chemoembolization（ TACE） in the treatment of primary liver cancer in high- risk locations. Methods The patients with primary liver cancer in high- risk locations who were diagnosed and treated from January 2011 to December 2015 were enrolled. All the patients underwent TACE followed by CT- guided RFA 3- 5 days later. The treatment outcome and adverse events were observed. Results A total of64 patients with 76 lesions were enrolled and all of them completed TACE and RFA. At one month after surgery,the complete tumor ablation rate was 81. 5%（ 62/76）. The patients were followed up for 6 to 64 months after surgery; at the end of follow- up,the local tumor progression rate was 28. 9%（ 22/76）,and the 1-,2-,and 3- year survival rates were 90. 6%,78. 1%,and 64. 1%,respectively. The incidence rate of severe surgical complications during follow- up was 3. 1%（ one patient each experienced liver abscess and hematobilia）,and the patients achieved remission after medical treatment and interventional treatment without any sequel. Conclusion CT- guided RFA after TACE is a safe and feasible regimen for primary liver cancer in high- risk locations.