不可逆电穿孔消融在肝恶性肿瘤局部治疗中的应用

Safety and efficacy of irreversible electroporation ablation in treating liver cancer

目的探讨不可逆电穿孔消融在肝恶性肿瘤局部治疗中的应用效果和安全性。方法回顾性分析2018年9月至2019年8月天津市第一中心医院因肝恶性肿瘤接受不可逆电穿孔消融治疗的21例患者的临床资料,其中男性17例,女性4例,中位年龄57.9(48,69)岁。根据Clavien-Dindo并发症分级系统对并发症进行分级。以改良实体瘤疗效评价标准评估肿瘤反应情况。记录患者肿瘤大小、手术时间等临床资料。随访患者肿瘤复发及生存情况,随访截至2020年8月27日。结果21例患者中,肝功能Child-Pugh A级20例,Child-Pugh B级1例,消融术后没有出现肝功能降级情况。肿瘤长径为10~56 mm,肿瘤长径≥3 cm者共7例。21例患者共接受21次不可逆电穿孔消融治疗,技术成功率为100%。本组病例手术时间为2.3(1.5,3.5)h,术后所有的并发症均为Clavien-DindoⅠ级,包括疼痛、发热和臂丛神经拉伤。术后4周影像学检查结果显示,完全缓解率为85.7%(18/21),部分缓解率为9.5%(2/21),疾病稳定者0例,疾病进展者1例,占4.8%(1/21),客观缓解率达到95.2%(20/21)。术后3和12个月复查,3个月总体复发率9.5%(2/21),12个月的总体复发率23.8%(5/21),均为异位复发。术后3、12个月的AFP分别为(28.0±7.3)和(29.0±8.1)ng/ml,与术前(278.0±41.2)ng/ml相比均降低,差异具有统计学意义(t3个月=-3.57,t12个月=-4.12,P<0.05)。结论不可逆电穿孔消融治疗对于肝脏恶性肿瘤是一种安全有效的治疗方法。

Objective To evaluate the safety and efficacy of irreversible electroporation ablation for liver cancer.Methods A retrospective study was conducted on 21 patients who underwent irreversible electroporation ablation for liver cancer from September 2018 to August 2019.There were 17 males and 4 females,with a median age of 57.9(48,69)years old.Complications were graded according to the Clavien Dindo complication grading system.Tumor response was evaluated by the improved evaluation standard of solid tumor efficacy.Clinical data such as tumor size and operation time were recorded.Tumor recurrence and survival outcomes were followed-up until August 27,2020.Results All patients had well-compensated cirrhosis(Child-Pugh A 20 cases,Child-Pugh B 1 case).There was no persistent deterioration of liver function after ablation.The diameter of tumor ranged from 10 to 56 mm,with 7 patients having a tumor diameter over 3 cm.Each of the 21 patients received only once irreversible electroporation ablation and the technical success rate was 100%.The operation time was 2.3(1.5,3.5)h.All complications were Clavien Dindo gradeⅠ,which included pain,fever and brachial plexus strain.Imaging examination 4 weeks after treatment showed a complete remission rate of 85.7%(18/21),a partial remission rate of 9.5%(2/21),a stable disease rate of 0(0/21),and a progressive disease rate of 4.8%(1/21).The objective remission rate was 95.2%(20/21).Overall recurrence rates were 9.5%(2/21)at 3 months and 23.8%(5/21)at 12 months.AFP at 3 and 12 months after treatment were(28.0±7.3)and(29.0±8.1)ng/ml,respectively,which were significantly lower than that before treatment(278.0±41.2)ng/ml(t3m=-3.57,t12m=-4.12,P<0.05).Conclusion Irreversible electroporation ablation was safe and effective in treating malignant liver tumors.