目的评价射频消融术(RFA)对于结直肠癌术后肝转移的治疗效果.方法搜集2008年3月至2009年3月56例结直肠癌术后肝转移癌患者的临床资料进行分析,其中男31例,女25例；年龄22~80岁,平均(56±10)岁；肿瘤最大径1.5~10.0 cm,平均(4.5±2.2)cm.其中单发转移灶35例,多发转移21例,共98个病灶.患者均为结直肠癌术后肝转移全身化疗失败或无法耐受,且无其他脏器转移证据者.所有患者均行CT引导下肝脏穿刺活检病理证实.术后每个月行肝功能、血象、肿瘤标记物检查,每3个月行腹部CT增强扫描1次.对于随访过程中肿瘤的局部残存及复发,在可能的前提下仍行RFA治疗.根据治疗后的影像表现分为病灶完全消融组和病灶部分消融组2个亚组.随访终点事件为患者死亡.对所有患者的整体生存期及两个亚组的生存期采用SPSS18.0统计分析软件,Kaplan-Meier方法进行统计分析.结果 RFA全部采用经皮途径在气管插管静脉复合麻醉下完成.32例患者经过1次或多次治疗后达到局部病灶完全消除(病灶完全消融组)；24例患者病灶部分消除(病灶部分消融组).随访时间l0~48个月,平均(25±10)个月.死亡33例,至今存活23例.中位生存期27个月(95%可信区间：24~32个月).至观察终点1、2、3年生存率分别为80.4%(46/56例)、71.4%(40/56例)、41.1%(23/56例).病灶完全消融组和部分消融组的3年生存率分别为68.8%(22/32例)和4.3%(1/24例),差异有统计学意义(P<0.01).结论 RFA可以有效控制结直肠癌肝转移患者肝内病变的进展,延长患者生存期.% Objective To describe the results of radio-frequency (RF) ablation study in patients with hepatic metastases from colorectal carcinoma. Methods From Mar.2008 to Mar.2009,31 males and 25 females metachronous colorectal carcinoma hepatic metastases were enrolled in this study. Mean age of the patients was (56±10)(22~80) years. Tumor size was (4.5±2.2) cm (min.1.5cm, max.10cm). Totally 98 lesions were treated with single metastasis in 35 cases and multiple ones in 21 cases. All cases were failed to chemotherapy or could not stand for the side effect of chemotherapy. All patients were conformed by biopsy guided by CT. Contrast enhanced CT scan was given to all patients before RFA. As for follow up, blood check was given monthly. Enhanced CT scan was given every 3 month. For residual lesions or recurrent lesions, RFA were given repeatedly. The whole patients was divided into two groups according to the image follow up including complete ablation group and partial ablation group. For complete ablation group, no further treatment was given. For partial ablation group, if it was not suitable for further RFA, TACE or TAI was given there after. The end point of follow up was death event. Survival of the whole group and the two subgroups was analyzed statistically by Kaplan-Meier method. Results All RFA procedures was given under intravenous anesthesia. Lesions in 33 patients were completely ablated after single or multiple sections of RFA. Twenty-three patients were in the partially ablated group. Follow up time was (25±10)(10~48) month. Thirty-three patients died and 23 kept alive during the follow up time. The estimated median survival time was 27 month (95% CI:24~32 months). Survival ration at 1,2,3 years for the whole group was 80.4%(46/56),71.4%(40/56),41.1%(23/56) for the whole group. The 3 years survival for complete and partial ablation group was 68.8%(22/33),4.3%(1/23), there was a significant difference between the two groups (P<0.01). Conclusion For patients with hepatic metastases from colorectal carcinoma, RFA can effectively control the local lesion. Complete ablation is the key point for a better survival.
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