射频与手术治疗肝癌的临床应用比较分析

Radio frequency ablation and operation on hepatocellular carcinoma

目的 研究射频原位灭活技术在肝癌治疗中的应用及疗效 ,并与手术治疗相比较 .方法 肝癌患者 14 4例 ,其中手术治疗组 36例常规行规则和不规则肝切除术 ;射频治疗组10 8例在 B超引导下 ,将金属钛穿刺针经皮直接置入肿块中心 ,分点多次行射频治疗 .射频输出功率由 10 W每隔 1min增加 10 W,加至 90 W,每点治疗时间设定为 15 m in,观察患者术后肝切、AFP、B超、CT图像及病理变化 .结果 手术组及射频组患者均有转氨酶升高 [手术组术前 (95 .0± 35 .0 )nkat· L- 1 ,手术后 (6 0 0 1.2± 5 0 3.4 ) nkat· L- 1 ;射频组术前(12 6 .7± 2 1.7) nkat· L- 1 ;术后 (385 0 .8± 315 .1) nkat·L- 1 ].且以手术治疗组肝功损伤大 ;肝癌标证物甲胎蛋白 (AFP)手术组患者术后复查降为正常 ,射频治疗组患者 2wk后复查 71/ 97(73.1% )下降为正常 ,经第二次治疗 94 / 97例下降为正常 .B超及 CT、手术组患者复查报告为肝切除术后改变 ,射频治疗组患者表现为肿瘤无增大 16 / 10 8(14 .8% ) ,缩小或液化 92 / 10 8(85 .2 % ) .术后病理复查示治疗区为坏死组织伴血管栓塞 ;1a生存率手术组为 6 9.4 %(2 5 / 36 ) ,射频治疗组 6 3.9% (6 9/ 10 8) ,二者无显著差异 .结论 与手术治疗相比 ,射频治疗不失为一种创伤小 ,安全 ,

AIM To evaluate the results and feasibility ofultrasound guided radio frequency ablation for the treatment of primary or secondary liver tumors and to compare with the operation results. METHODS 144 patients with liver tumor were treated with formula / nor formula hepatectomy or percutaneous, ultrasound guided RF ablation. RF was applied with frequencies at 10 W to 90 W for 15 min over multi treatment session. After the treatment, the AFP level changes were observed and the ultrasonograph, computer tomography (CT) and biopsy were performed. RESULTS The LPT increased both in the operated group and the RF group [operative group pre operation (95.0±35.0) nkat·L -1 , post operation (6001.2±503.4) nkat·L -1 ; RF group (126.7± 21.7 ) nkat·L -1 ; post operation (3850.8±315.1) nkat·L -1 ].In those at abnormal AFP level, AFP decreased to normal in all the operated patients. 2 weeks after RF treatment, AFP fell to normal in 71/97. 4 weeks later or after the second treatment, AFP dropped to normal in 94/97 patients.After hepatectomy, CT and B ultrasonograph were reported as pathologic change post operation in the operated group. In the RF group, 16 patient lesions did not increase in size and 92 lesions decreased in size or liquified at computered tomography and/or ultrasonography. The biopsy results of the treated lesions showed necrosis accompanied with microvessels embolism. 1 year survival rate was 69.4% (25/36) in the operated group and 63.9% (69/108) in the RF group, indicative of no significant difference. CONCLUSION Compared with hepatectomy, RF ablation appears to be a less invasive, safe and effective treatment for primary and secondary liver tumor.