CT引导下放射性^(125)I粒子植入治疗特殊部位小肝癌的临床疗效评价

Clinical Evaluation of CT-Guided ^(125)I Seed Implantation in the Treatment of Small Hepatocellular Carcinoma

目的评价CT引导下放射性^(125)I粒子植入治疗特殊部位原发性小肝癌的临床疗效。方法回顾性分析77例原发性小肝癌患者,其中^(125)I粒子植入组33例,病灶均位于靠近胆囊、肝门、胃肠、肾脏、尾状叶、大血管等特殊部位;射频消融组44例,均位于远离以上特殊部位的消融安全区域。比较两组患者1年、2年、3年肿瘤局部复发率,治疗前后肝功能变化、治疗前及治疗后2个月甲胎蛋白变化及不良反应发生率。结果治疗后粒子植入组、射频消融组1年、2年、3年肿瘤局部复发率分别为13.5%、29.7%、48.6%和26.1%、41.3%、50%;在控制小肝癌局部复发方面,粒子植入组的局部肿瘤复发率略低于射频消融组,但两者之间对比差异无显著统计学意义(χ^(2)=1.99,P=0.158;χ^(2)=1.19,P=0.275;χ^(2)=1.00,P=0.903);治疗后肝功能对比粒子植入组优于射频消融组;治疗后2个月靶病灶完全灭活,两组甲胎蛋白对比无差异(P>0.05);两组均无严重不良反应事件发生。结论与射频消融治疗安全部位小肝癌相比,放射性^(125)I粒子植入在治疗特殊部位小肝癌方面疗效与此相当,同样可以达到肿瘤完全灭活的效果,且术后对肝功能的损伤明显低于射频消融。

Objective To evaluate the clinical efficacy of CT-guided radioactive ^(125)I seed implantation in the treatment of special site small hepatocellular carcinoma(SHCC). Methods A total of 77 patients with SHCC admitted were retrospectively analyzed.In the ^(125)I seed implantation group, 33 cases were located near the gallbladder, porta hepatis, gastrointestinal tract, kidney, caudate lobe, large blood vessels and other special parts;in the radiofrequency ablation(RFA)group, 44 cases were located far away from the above special parts.The 1-year, 2-years and 3-years local recurrence rates, liver function changes before and after treatment, alpha fetoprotein changes before and 2 months after treatment and the incidence of adverse reactions were compared between the two groups. Results After treatment, the local tumor recurrence rates in the seed implantation group and RFA group at 1 year, 2 years, and 3 years were 13.5%,29.7%,and 48.6%;26.1%,41.3%,and 50%,respectively.In the control of local recurrence of SHCC,the local tumor recurrence rate of seed implantation group was slightly lower than that of RFA group, but there was no significant difference between the two groups(χ^(2)=1.990,P=0.158;χ^(2)=1.19,P=0.275;χ^(2)=1.00,P=0.903).After treatment, the liver function of the particle implantation group was better than that of the RFA group.After 2 months of treatment, the target lesion was completely inactivated, there was no difference between the two groups(P> 0.05),and there was no serious adverse reaction event in the two groups. Conclusion Compared with RFA in the treatment of SHCC at safe sites, radioactive ^(125)I seed implantation has the same curative effect in the treatment of SHCC at special sites.It can also achieve the effect of complete tumor inactivation, and the postoperative damage to liver function is significantly lower than RFA.