肝动脉化疗栓塞术联合射频消融治疗肝内特殊部位恶性肿瘤

摘要

Objective To evaluate the safety and effectiveness of the combined therapy with transcatheter arterial chemoembolization ( TACE) and radiofrequency ablation ( RFA) for liver malignancy at high-risk locations. Methods Between June 2009 and January 2014, fifty-two patients with liver malignancy at high-risk locations (including 43 cases of primary liver cancer and 9 cases of hepatic metastases) were enrolled in the study. All the patients received TACE and followed with RFA performed under the guidance of ultrasonography plus CT scanning (50 cases) or X-ray fluoroscopy (2 cases). The follow-up period was 12 months. Safety effectiveness was evaluated by observation of the relevant complications during or directly after RFA procedure, and also at 1 week, 1-month, 3-month, 6-month and 12-month after RFA. Complete ablation was defined as no viable sign of residual tumor confirmed by enhanced CT or MRI after 12-month’ s follow-up. Effectiveness of TACE+RFA was evaluated by complete ablation rate at the end of follow-up time. Results All the 52 patients underwent successful TACE + RFA. There were no significant complications observed after the procedure or during the follow-up period. By the end of the follow-up at 12-month postoperation, all the patients survived. The tumor had been completely abalted in 49 cases (94. 2%). Incomplete ablation with residual tumor signs was detected by enhanced MRI or CT in 3 ( 5. 8%) of the 52 cases, which was given continoues TACE treatment. Conclusions TACE combined with RFA is a safe and effective therapy for liver malignancy at high-risk locations. Moreover, precise image guidance with X-ray, ultrasonography and CT and experiences and skills of operators are quite important for a successful RFA at high-risk locations.%目的：探讨肝动脉化疗栓塞术( transarterial chemoembolization,TACE)联合射频消融术( radiofrequency ablation, RFA)治疗肝内特殊部位恶性肿瘤的安全性、可行性。方法2009年6月~2014年1月52例肝内特殊部位恶性肿瘤(原发性肝癌43例,肝转移癌9例)均先行TACE治疗,TACE术后适时行RFA。 RFA引导方式为超声联合CT,或X线透视正侧位引导。 RFA术后即刻,术后1周,1、3、6、12个月进行血液学及影像学检查评价有无并发症发生,并进行局部肿瘤活性的全面评估。结果52例均顺利完成TACE联合RFA治疗。术后即刻、1个月、3个月、6个月复查无手术相关并发症发生。随访12个月,全部存活,49例(94.2%)肿瘤达到完全消融；3例(5.8%)肿瘤影像学表现有局部残存征象,为不完全消融,继续行TACE。结论 TACE联合RFA能够有效灭除肝内特殊部位恶性肿瘤,具有安全、有效,可重复的特点。