射频消融在肝细胞癌综合治疗中的作用

摘要

With the widely use of radiofrequency ablation (RFA) in the comprehensive treatment for hepatocellular carcinoma (HCC),both the related basic and clinical research become more and more systematic.Accordingly,its role in the management of such patients is being increasingly definite,mainly including the following aspects:(1) For early HCC (≤3.0 cm) patients,under the premise of individualized strategies,RFA can be used as the first line treatment with the therapeutic efficacy comparable to those of liver resection and transplantation.(2) For selected patients with medium sized (3.1 ～ 5.0 cm) and unresectable HCC lesion,local RFA combined with transarterial embolization can experientially obtain satisfactory outcome.(3) For unresectable solitary large HCC (＞5.0 cm),repeated RFA combined with other local therapeutic tools could get satisfactory therapeutic efficacy.(4) For intrahepatic recurrent HCC,if the number of lesions is limited,RFA can be applied as the treatment of choice in most patients.(5) Emergency RFA is an effective strategy for achieving hemostasis in patients with ruptured HCC,and RFA could maximally eradicate the tumor.(6) For HCC patients awaiting liver transplantation,bridge strategy with RFA debulking may prolong long-term survival.(7) RFA can safely assist liver resection and reduce the bleeding.(8) RFA treatment,especially repeated RFA,can induce positive tumor specific immunoregulation.Taken together,these roles of RFA will help facilitate the transition in the HCC treatment mode.%随着射频消融(RFA)在肝细胞癌(HCC)综合治疗中的广泛应用,其理论体系日渐完善,学术地位日益明确,主要包括:(1)对于早期HCC(≤3.0 cm),在个体化策略前提下,RFA可作为首选获得与外科手术相似的疗效;(2)对于有选择的中等体积HCC(3.1 ～5.0 cm),在经验充分的前提下,以RFA为主的局部治疗可获得满意的疗效;(3)对于不能手术切除的孤立性大HCC(＞5.0 cm),可通过以重复RFA为主的局部治疗策略获得满意疗效;(4)对于病灶数量有限且局限于肝内的复发性HCC,RFA多可作为首选;(5)对于HCC急性破裂出血,RFA作为重要的辅助性措施,既可以有效止血,又可以最大程度地清除癌灶;(6)对于等待肝移植的HCC患者,RFA减瘤可有效延长患者生存期;(7)RFA辅助性肝切除可显著减少出血量;(8)RFA,特别是重复RFA治疗,可产生正向的机体肿瘤免疫调节作用.RFA的上述作用有助于推进HCC治疗模式的转型.