肝动脉化疗栓塞联合CT引导热消融治疗肝内胆管癌

Transcatheter hepatic arterial chemoembolization combined with CT-guided thermal ablation for the treatment of intrahepatic cholangiocarcinoma

目的探讨TACE联合CT引导热消融(射频/微波)治疗肝内胆管癌(ICC)的疗效及安全性。方法回顾分析2009年9月至2013年7月用TACE序贯CT引导下RFA/MWA治疗病理诊断的ICC患者14例,18个病灶,病灶最大径(多个病灶取最大径之和)2.2~7.2 cm,平均(4.2±1.4)cm。TACE随访病灶的完全消融率、手术并发症、无瘤生存时间及总生存时间。结果 15个病灶实现了完全消融,肿瘤的完全消融率为83.3%(15/18),中度并发症的发生率为6.2%,无严重并发症及死亡患者。术后随访6~44个月,平均(16.0±10.3)个月。至随访结束,死亡6例(42.9%,6/14)。完全消融患者的中位无瘤生存时间为17个月,全组患者的中位生存时间为20个月,1、2、3年总体生存率分别为82.5%、41.3%及20.6%。结论TACE联合CT引导热消融可作为ICC治疗的选择之一。

Objective To investigate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with CT-guided thermal ablation （radiofrequency ablation or microwave ablation） in treating intrahepatic cholangiocarcinoma. Methods The clinical data of 14 patients with pathologically- proved intrahepatic cholangiocarcinoma, who were admitted to authors＇ hospital during the period from September 2009 to July 2013 to receive TACE with subsequent radiofrequency ablation （RFA） or microwave ablation （MWA）, were retrospectively analyzed. A total of 18 lesions were detected in the 14 patients. The maximal diameter of the lesion （or the sum of maximal diameters if there were multiple lesions） ranged from 2.2 cm to 7.2 cm （mean 4.2±1.4 cm）. After TACE, the lesion＇s complete ablation rate, surgical complications, tumor-free survival time and overall survival time were evaluated. Results Complete ablation was obtained in 15 lesions （83.3%, 15/18）. The incidence of moderate complications was 6.2%, and no severe complications or death occurred. After the treatment, the patients were followed up for 6-14 months, with a mean of （ 16.0±10.3） months. At the end of follow-up, 6 patients （42.9%, 6/14） died. The median tumor-free survival time in patients whose lesions obtained complete ablation was 17 months. The median survival time of all patients was 20 months. The 1-, 2- and 3-year overall survival rates were 82.5%, 41.3% and 20.6% respectively. Conclusion TACE combined with thermal ablation can be regarded as one of the treatment options for intrahepatic cholangiocarcinoma.