超声引导下经皮射频消融治疗尾状叶肝细胞癌的疗效

Ultrasound-guided percutaneous radiofrequency ablation to treat hepatocellular carcinoma in the caudate lobe

目的探讨超声引导下经皮射频消融治疗尾状叶肝细胞癌的可行性及临床价值。方法纳入2006年11月至2017年6月于中山大学附属第一医院行超声引导下经皮射频消融的尾状叶肝细胞癌的患者31例。记录消融效果和并发症情况，计算肿瘤局部进展率、患者累积生存率和无瘤生存率。结果31例患者中，26m一次完全消融，5例不完全消融，补充射频消融后均达到完全消融，平均消融次数（1．16±0．37）次。术后随访3～65个月，19例死亡，10例存活，2例失访。1年、2年、3年和5年总体累积生存率分别为78．4％、48．5％、12．1％和12．1％。随访期间，9例患者HCC消融后出现肿瘤局部进展，1年、2年和3年局部进展率分别为21．5％、41．6％和41．6％。1年、2年和3年无瘤生存率分别为22．3％、11．2％和11．2％。4例出现消融相关并发症。结论超声引导下经皮射频消融治疗尾状叶HCC是安全、有效的，消融后应密切随访。

Objective To study the feasibility, efficacy and safety of ultrasound- guided percutaneous radiofrequency ablation （RFA） in the treatment of hepatocellular carcinoma （HCC） in the caudate lobe. Methods From November 2006 to June 2017, 31 patients with 31 HCCs located in the caudate lobe were treated with percutaneous RFA at the First Affiliated Hospital of Sun Yat-sen University. The treatment efficacy, complications, and the local tumor progression （LTP）, disease-free survival （DFS） and overall survival （OS） rates were analyzed. Results Residual tumors were detected in 5 patients after the first treatment. Complete necrosis was achieved in all the patients after the second treatment. The mean number of ablation sessions was 1.16＋0.37. At a follow-up period which ranged from 3 to 65 months, 19 patients had died, 10 patients were still alive, and 2 patients were lost to follow-up. The 1-, 2-, 3-, and 5- years OS rates were 78.4%, 48.5%, 12.1% and 12.1%, respectively. On follow-up, 9 caudate lobe HCC lesions were detected to have LTP. The 1-, 2-, and 3-years LTP rates were 21.5%, 41.6% and 41.6%, respectively; while the 1-, 2-, and 3-years DFS rates were 22.3%, 11.2% and 11.2%, respectively. Ablation- related complications were detected in 4 patients. Conclusions Ultrasound-guided percntaneons RFA was safe and effective for patients with HCC in the caudate lobe. These patients should be followed-up closely to detect LTP.