目的 评价微波消融治疗结直肠癌肝转移的治疗效果.方法 2004年1月至2011年8月超声引导下微波消融治疗结直肠癌肝转移患者24例共70个病灶.男性15例,女性9例,中位年龄66岁(44～78岁).所有病灶的直径均在0.8～5.0 cm,患者总共接受了30次微波消融手术.经皮穿刺微波消融19次共35个病灶;开腹消融11次共35个病灶.定期随访观察消融效果,并采用Kaplan-Meier法进行生存分析.结果 全组无围手术期死亡,相关并发症发生率为6.7%.11次开腹微波消融术术中B超发现45个病灶,多于术前B超发现的38个病灶和CT检查发现的35个病灶.11次开腹微波消融术后1个月病灶均完全坏死,19次经皮微波消融术后1个月的病灶完全坏死率为88.6%(P=0.122).直径≤3.0 cm的病灶坏死率为96.4%,3.1～5 cm的病灶坏死率为85.7%(P=0.212).24例患者全部得到随访,随访时间为18～75个月.术后第3个月和第6个月时,19例经皮消融的患者分别有3例和10例出现肝内新发转移灶,而开腹消融术后复发者分别为0例和1例(P=0.046).全组患者的中位生存期为28个月,1、2、3年生存率分别为83.3%、54.3%、23.3%.结论 开腹微波消融术后较经皮消融早期肝内新发转移灶的发生率较低.微波消融是治疗直径≤5 cm的结直肠癌肝转移的安全有效方法.%Objective To evaluate the therapeutic efficacy of microwave ablation (MWA) for patients with liver metastases of colorectal carcinoma. Methods From January 2004 to August 2011, Totally 24 patients (M:15; F:9) with liver metastases of colorectal carcinoma (70 liver metastatic lesions) underwent ultrasound-guided WMA in our center. Their median age was 66 years ranging from 44 to 78 year old and lesion diameters ranged from 0. 8 cm to 5. 0 cm. All the patients underwent 30 MWA , including percutaneous MWA in 19 cases with 35 lesions and open MWA in 11 patients with 35 lesions. Postoperative chemotherapy was administrated for all patients and MWA efficacies were monitored regularly via CT or MRI scanning outcomes. Follow-up results statistics were conducted using Kaplan-Meier survival analysis. Results No death was observed in perioperative period. The occurrence rate of postoperative complication correlated to MWA therapy was 6. 7%. For 11 patients treated with open MWA , the 45 lesions were detected by intraopcrative ultrasound (IOUS) , which was more than that by preoperative ultrasound report (38) or CT scanning reports (35). The complete tumor necrosis rate was 100% in post-operative 1 month for open MWA and 88. 6% for percutaneous MWA (P - 0. 122). The complete tumor necrosis rate was 96. 4% in small lesions (≤3. 0 cm) and 85. 7% in those ranging 3. 1 to 5.0 cm (P - 0. 212). All patients were followed-up for 18-75 months. Among patients undergoing percutaneous MWA , new lesions in liver were detected in 3 patients in post-operative 3 months, and 10 patients in post-operative 6 months respectively, in contrast, 1 patient undergoing open MWA was found hepatic recurrence in post-operative 6 months (P = 0. 046). The median survival time for all patients was 28 months, and the 1-, 2-, and 3-ycar survival rates were 83.3%, 54. 3 % , and 23. 3 % respectively. Conclusion The early hepatic recurrent rate for open MWA is lower than percutaneous operations. WMA is a safe and effective method to treat hepatic metastases of colorectal cancer with no more than 5 cm in size.
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