经皮微波消融治疗肝内胆管细胞癌的疗效分析

摘要

目的 探讨肝内胆管细胞癌(ICC) 经皮微波消融治疗的有效性.方法 对病理诊断为ICC的26例患者47个结节(最大径1.0～9.9 cm,平均2.9±1.8 cm)行超声引导下经皮微波消融治疗.消融治疗范围超过癌周1.0 cm.治疗后定期随访4～35个月,随访期间微波消融灶内或周边超声造影增强影像出现新发病变视为局部肿瘤进展.结果 超声引导下对26例ICC 45个结节行根治性微波消融治疗,消融后1个月超声造影或增强MRI显示40个消融灶内或边缘无增强表现,达到完全消融;5个消融灶内或边缘有增强表现,为局部肿瘤进展,消融治疗有效率为88.9%(40/45);另2个结节行姑息性微波消融治疗.随访期内6个结节消融后发生局部肿瘤进展,局部进展率为13.3%(6/45).全组26例患者经皮微波消融治疗后6、12和24个月累计生存率分别为80.8%(21/26)、61.5%(16/26)和53.8%(14/26).术后并发症发生率为19.2%(5/26),包括肝脓肿4例(抗感染和置管引流后均治愈),针道种植1例(外科手术切除治愈).结论 超声引导下经皮微波消融ICC安全有效,可作为不适合手术切除ICC患者的治疗选择.%Objective To investigate the safety and efficacy of the percutaneous microwave ablation of intrahepatic cholangiocarcinoma ( ICC ). Methods Pathological diagnosed in 26 patients with ICC,and a total of 47 lesions( maximum diameter of 1. 0-9. 9 cm, mean 2. 9 ± 1. 8 cm ) were treated with ultrasound-guided percutaneous microwave ablation. The range of ablation treatment of ICC was 1. 0 cm over the noncancerous. In the follow-up period,new lesions appearing in the contrast-enhanced ultrasound imaging in or around the microwave ablation lesions were regarded as local tumor progression. The regular follow-up period was 4-35 months. Results Forty-fivenodules underwent radical microwave ablation, and 40 ablation lesions achieved complete ablation, which were shown in contrast-enhanced ultrasound or MRI without internal or edge enhanced performance 1 month later. While other 5 ablation lesions with internal or edge enhanced performance were local progression, and the technique effective rate was 88. 9%( 40/45 ). The other two nodules used palliative treatment of microwave ablation. The local progression rate was 13. 3% ( 6/45 ). The 6, 12,24 months cumulative survival rates of 26 cases were 80. 8%( 21/26 ),61. 5%( 16/26 ) and 53. 8%( 14/26 ). The major complication rate was 19. 2%( 5/26 ),including liver abscess in 4 cases and needle tract planting in 1 case. Both complications were overcomed with antibiotic treatment combined with catheter drainage for abscess and resection for needle tract seeding. Conclusion Percutaneous microwave ablation is a safe and effective method for the ICC,and it can be used as a treatment option for the ICC patients who are not suitable for surgical resection.