C臂CT引导下经皮穿刺射频消融术治疗原发性肝癌的临床应用

Clinical application of C-Arm cone beam computed tomography guided percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma

目的探讨C臂CT(CBCT)引导下经皮穿刺射频消融术治疗原发性肝癌的应用价值。方法选取322例原发性肝癌患者共351个病灶,行射频消融治疗378例次。137例患者在螺旋CT(Spiral Computed Tomograph, SCT)引导下行射频消融165例次(SCT组),185例患者在CBCT引导下行射频消融213例次(CBCT组)。结果手术技术成功率为100%。术后1个月疗效评估,SCT组与CBCT组临床缓解率分别为97.0%(133/137)、96.2%(177/185)。术后总死亡率0.31%(1/322),总并发症发生率为4.1%(15/378),其中SCT组为10.9%(18/165),CBCT组为2.3%(5/213),两者比较有显著性差异(χ^2=11.93,P<0.05)。结论 CBCT引导下经皮穿刺射频消融术治疗原发性肝癌具有可行性和安全性,优点是实时监测、定位准确、可以多角度、不受其他脏器的干扰、时间短。缺点是术者要直接接触射线。没有碘油沉积或没有明确标记显示不清的病灶,则需结合术前CT或MRI结果准确定位。

Objective To investigate the clinical feasibility,safety and application value of percutaneous radiofrequency ablation(RFA)guided by C-Arm cone beam computed tomography(CBCT)in the treatment of hepatocellular carcinoma(HCC).Methods A retrospective study was conducted on the clinical data of 378 RFA treatments to 351 HCC nodules in 322 patients during a 10-year period between January 2008 and January 2018.A total of 165 lesions were performed under Spiral CT guided in 137 patients(SCT group)and 213 lesions in 185 patients guided by CBCT real-time fluoroscopy and three-dimensional image reconstruction virtual navigation system(CBCT group).Results The technical success rate was 100%(378/378)in all patients.The clinical response rates were 97.0%(133/137)(Spiral CT-guided)and 96.2%(177/185)(CBCT-guided),respectively.One among 322 patients(0.31%)died.Among the patients,complications occurred in 4.1%(15/378).The rate of complications for the Spiral CT-guided RFA was 10.9%(18/165),whereas that for the CBCT-guided RFA was 2.3%(5/213),respectively.There was a significant difference between the two groups(χ^2=11.93,P<0.05).Conclusion CBCT guided percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma is feasible and safe.The advantages are real-time,accurate positioning,multiple angles,no interference from other organs,and short time cost.However,the disadvantage is that doctors should be exposed to the X-ray.In addition,for the absence of lipiodol deposits or unclear lesions under the fluoroscopy,preoperative CT or MRI images must be combined with for accurate positioning.