经皮射频消融治疗邻近膈顶较大肝癌

Radiofrequency ablation in treatment of large hepatic carcinoma adjacent to diaphragm

目的探讨经皮射频消融(RFA)治疗邻近膈顶的较大肝癌的价值。方法回顾性分析接受超声引导下经皮RFA治疗的176例邻近膈顶较大病灶原发性肝癌患者(近膈组)及157例非邻近膈顶的较大病灶原发性肝癌患者(对照组)的资料。分析比较2组间患者年龄、性别、消融情况、早期灭活率、复发率、肿瘤新生率、并发症发生率及生存率的差异。结果近膈组RFA治疗中膈下注射生理盐水的比例高于对照组(P=0.016),局部复发率高于对照组(P=0.028)。2组患者年龄、性别、病灶最大径、RFA治疗所用消融仪及电极针、肿瘤早期灭活率、肿瘤新生率、并发症发生率差异均无统计学意义(P均>0.05),RFA治疗后1、2、3、4、5年的生存率差异无统计学意义(P=0.203)。结论邻近膈顶的较大肝癌更易复发,超声引导下经皮RFA治疗应采取膈下注射生理盐水等个体化治疗方案及策略。

Objective To investigate the value of percutaneous radiofrequency ablation （RFA） in the treatment of large hepatic carcinoma adjacent to diaphragm. Methods Totally 176 patients with larger hepatic carcinoma adjacent to dia- phragm （adjacent diaphragm group） and 157 patients with larger hepatic carcinoma not adjacent to the diaphragm （control group） underwent ultrasound-guided percutaneous RFA treatment, and the data of these patients were retrospectively ana- lyzed. The patients＇ age, gender, the largest diameter of lesions, ablation information, early necrosis rate, recurrence rate, new tumor rate and survival rate were analyzed and compared between the two groups. Results Cases of injection physio- logical saline below the diaphragm during RFA were significantly higher in adjacent diaphragm group than that in control group （P=0. 016）. The recurrence rate of adjacent diaphragm group was significantly higher than that of control group （P^0. 028）. There was no significant difference of patients＇ age, gender, the largest diameter of lesion, RFA instrument, RFA needles, early necrosis rate, new tumor rate, nor complications rate between the two groups （all P^0.05）. There was no significant difference of the 1-, 2-, 3-, 4- and 5-year survival rate between the two groups （P=O. 203）. Conclusion Large hepatic carcinoma adjacent to diaphragm is more likely to recur after ultrasound-guided percutaneous RFA. The method of injection physiological saline below diaphragm and other individualized treatment plan and strategy should be used during RFA treatment.