Objective:To investigate the efficacy and safety of the cold-cycle microwave ablation in combination with TACE in treating primary hepatocarcinoma.Methods:Forty-five cases of primary hepatocarcinoma were chosen.They were treated with trans-hepatic arterial in fusion chemotherapy and embolism (TACE).Most chemotherapeutic regimens were two-agent combinations (EPI + CDDP,GEM + CDDP or 5-FU + CDDP),and embolism agents included superliquid lipiodol (dose was given based on the volume and blood supply of tumor and hepatic function,usually 5 to 15 ml) and gelatin sponge.Patients whose tumors were well lipiodol-deposited were treated with TACE once a month for two to three times,then their reciduary foci were further treated with cold-cycle microwave ablation (power was 50 to 60W,each locus should be treated for 20 to 30 minutes).For patients whose tumors were badly lipiodol-deposited because of poor blood supply,they received cold-cycle microwave ablation after the first TACE (with the same power and time as those aforementioned).When all treatments finished,alterations of embolism/melt degree of loci,clinical symptoms,AFP and liver/kidney functions and blood regular test were evaluated by weighted CT,MR or DSA(digital subtract angiography) tests.Follow-up time was 3 years after the last treatment.Results:Among 45 patients with primary hepatocarcinoma,34 cases had hypervascular tumors and underwent TACE treatment,including 0 of CR,70.6％ (24 of 34) of PR,17.6％ (6 of 34) of SD and 11.8％ (4 of 34) of PD,which achieved a clinical beneficial rate of 88.2％.Up to 62 hypervascular and hypovascular loci remained after TACE treatment.Under cold-cycle microwave ablation therapy,complete necrosis of loci occurred in 48 cases (77.4％),incomplete necrosis of loci occurred in 5 cases (8.1％) and partial necrosis of loci occurred in 9 cases (14.5％).11 cases had AFP beyond 400μg/L prior to cold-cycle microwave ablation therapy,AFP of 7 cases dropped to normal level,AFP of 2 cases decreased significantly compared with that of pretreatment,2 cases showed no change in AFP.The 1,2 and 3-year survival rates were 73.3％,62.2％ and 37.8％,respectively.The main chemotherapy-associated side effects included nausea,vomiting and anorexia,aleucocytosis and thrombocytopenia were within grade Ⅱ to Ⅲ.Embolism and microwave ablation related effects were local pain (NRS 4 to 6) and fever (mild to moderate).Overall,the above adverse effects were fully relieved after sympotomatic treatment,without severe complications and surgery-related deaths.Conclusion:In the therapy of primary hepatocarcinoma,imaging-guided cold-cycle microwave ablation in combination with TACE showed merits of obvious curative effect,little trauma,high safety and easy operation,which made it an effective combined minimally-invasive treatment method in targeting primary hepatocarcinoma.%目的:观察冷循环微波消融联合TACE治疗原发性肝癌的有效性与安全性.方法:对入选的45例原发性肝癌患者首先采用肝动脉灌注化疗栓塞(TACE),化疗药物主要为2药联合(表阿霉素+顺铂,或吉西他滨+顺铂、氟尿嘧啶+顺铂),栓塞剂主要使用超液化碘油(根据肿瘤大小及血供、肝功能情况确定剂量,一般5-15ml)、明胶海绵.对于碘油沉积良好者,每月1次TACE,连用2-3次后,对残留病灶进行冷循环微波消融治疗(功率50-60W,每一病灶治疗时间10-20min).对于乏血供而碘油沉积差者,第一次TACE 2周后即进行冷循环微波消融治疗(功率与时间同前).完成治疗后1月通过强化CT、MR或数字减影血管造影判断病灶栓塞、消融程度,观察临床症状、AFP及肝肾功能、血常规等变化情况,其后进行疗效与不良反应评价.随访时间为最后1例治疗结束后3年.结果:45例原发性肝癌中,富血供而行TACE者34例,CR O例,PR70.6％ (24/34),SD 17.6％ (6/34),PD 11.8％ (4/34),临床获益效率88.2％.乏血供病灶及富血供行TACE后残留病灶共62个,冷循环微波消融治疗后,完全坏死者48个(77.4％)、不完全坏死者5个(8.1％)、部分坏死者9个(14.5％).行冷循环微波消融治疗前,有11例AFP＞ 400μg/L,术后1月复查降至正常者7例,较前明显下降者2例,无变化者2例.1、2、3年生存率分别为73.3％、62.2％、37.8％.与化疗相关的不良反应主要有恶心、呕吐、食欲下降,以及白细胞、血小板减少,多为Ⅱ-Ⅲ度.与栓塞及微波消融治疗相关的反应主要有局部疼痛(NRS评分4-6分)、发热(轻-中度).上述不良反应经对症处理后均完全缓解.全组无严重并发症及手术相关死亡发生.结论:在影像引导下的冷循环微波消融联合TACE治疗原发性肝癌具有疗效确切、创伤小、安全性高、操作简便的优势,是原发性肝癌有效的综合微创治疗方法之一.
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