螺旋CT导航多弹头射频消融肝癌的临床应用

Clinical application of radiofrequency ablating hepatic cancer through puncturing skin and liver leading by HCT

目的 探讨并总结螺旋CT导航经皮肝穿刺多弹头射频消融肝癌的特点、安全性及临床近期疗效。方法 对20例肝细胞肝癌及多发肝转移瘤共32个瘤灶在螺旋CT导航下,配合自制穿刺定位定角器,进行了多弹头射频治疗,共消融49个靶位,通过对治疗前后及随访3-8个月的螺旋CT检查的比较及AFP、自觉症状等的改变进行对比观察。结果 20例患者,49个靶位,一次性穿刺及消融操作技术成功率达100％,复查螺旋CT检查:术毕时20例(100％)瘤灶密度减低,其中15例(占75％)病灶内见散在气化影;术后2个月时,20例中的16例(占80％)瘤灶体积缩小10％-20％,增强扫描动脉期瘤灶不强化。另3例瘤灶体积缩小不明显,但动脉期不强化;1例瘤灶略显增大,系邻近门静脉一侧,消融不彻底,病灶呈偏向门静脉一侧生长,动脉期轻度强化;术后6个月时,20例中的8例(占40％)瘤灶体积缩小达20％-30％,动脉期不强化。1例于治疗术后6.5个月死于肝、脑、肺多发转多。术后1个月复查血AFP,20例中13例(占65％)下降,下降值40-210μg/ml,平均下降135.6μg/ml,其中有2例降至正常范围。治疗后2个月内所有患者自觉症状均明显改善。无手术死亡,术中及术后不良反应轻微,无重要并发症发生。结论经皮多弹头射频消融术,是一种安全、可靠、微创的局部疗法,具有较高的临床应用价值。采?

Objective To probe and sum up the character, safety and clinical short-term effect of radiofrequency ablation for hepatic cancer through puncturing skin and liver leading by HCT.Methods The 32 foci of 20 patients with hepatic cell cancer and multiple metastatic cancer were treated leading by HCT and matching self-made puncturing position finder; 49 target regions were ablated. The comparison was carried out after and before the treatment and follow-up of 3-8 months, and the change of AFP and subjective symptoms had been observed. Results The successfully operating technics of single puncture and ablation scored 100 percent in 42 target regions of 20 cases. Follow-up examinatiin with HCT: The density of the tumor foci was reduced (100%) in 20 cases after the operation, of whom 15 cases (takes 75%) were found tumor foci dissipating. In the second month after the operation, the foci of 16 in 20 cases(takes 80%) were constricted by 10%-20%; 3 cases were not remarkable, and one became slighly bigger. In the sixth month after the operation, the tumor foci of 8 in 20 cases were constricted by 20%-30%. There was no increase in the artery period.One died of multiple metastatic of liver, brain and lungs later six and half of months after the operation. The AFP of 13 in 20 cases (takes 65%) came down a month after the operation, the decrease value is 40-210μg/ml, the average was 135.6μg/ml,2 cases of them had came down to normal scale. The subjective symptoms of all the cases had remarkably improved within two months after the operation. No patients died of the operations. No major complications occured. Conclusion Radiofrequency ablating hepatic cancer through skin is a safe, reliable and micro-injury local therapy; its effect is satisfactory and has higher clinical application value. It can make the surgery operation performed accurately, safely, simply and quickly leading by HCT and matching with self-made puncturing position finder through skin. It is an ideal method for determining the ablation effect by HCT. It is a key to ensure the cure effect and preventing complications strictly mastering indications and contraindications, and making careful preparations before the operations and management during and after the operations.