肝动脉化疗栓塞术联合CT引导下射频消融治疗大肝癌的疗效和安全性

摘要

目的：评价肝动脉化疗栓塞术（ transcatheter arterial chemoembolization， TACE）联合CT引导下经皮穿刺射频消融治疗大肝癌的疗效及安全性。方法回顾性分析52例经穿刺病理或影像学诊断的大肝癌患者临床资料，患者均先行1次TACE术，术后2周复查增强CT，对碘油沉积欠缺的区域在CT导向下进行射频消融治疗，术后复查甲胎蛋白（ AFP）、增强MRI或CT评价肿瘤体积缩小及坏死情况，随访时间为12个月。结果52例（56个病灶）手术均获得成功。 TACE术前病灶最大径为（12．7±2．7）cm，射频术后1个月病灶最大径为（6．1±1．9）cm，肿瘤大小较术前均有不同程度缩小（t＝14．416，P＜0．05）。 TACE术前AFP值为（4156±689）ng／ml，射频术后1个月为（256±178）ng／ml，AFP值明显下降（t ＝39．485，P＜0．05）。其中完全消融（CR）26例，大部分消融（PR）21例，稳定（SD）4例，进展（PD）1例，总体有效率为90．4％，12个月生存率为92．3％。结论 TACE联合CT导向下射频消融治疗大肝癌是一种安全、有效、微创的治疗方法。%Objective To evaluate the efficacy and the application value of TACE combined with CT guided percutaneous ra-diofrequency ablation in the treatment of large hepatocellular carcinoma.Methods A retrospective analysis was made on clinical data of 52 patients proved by pathology and imaging diagnosis of hepatocellular carcinoma.All the patients received one TACE treatment, and were reexamined by contrast-enhanced CT two weeks thereafter.Then radiofrequency ablation was performed on the region lacking lipiodol deposition under CT guidance.Postoperatively, all the patients were reexamined by alpha fetoprotein, contrast-enhanced MRI or CT to evaluate the volume reduction and necrosis of tumors and were followed up for 12 months.Results The operations on all 52 patients (56 lesions) were successful without serious complications.The volumes of tumors decreased to varying degrees compared with the preoperative ones.The maximum of the diameters of the focuses was (12.7 ±2.7) cm before TACE, and the maximum of the di-ameters of the focuses was (6.1 ±1.9) cm after the RF ablation operations (t=14.416, P<0.05).The AFP values decreased sig-nificantly, with the AFP value before TACE being (4156 ±689) ng/ml and the AFP value after the RF ablation operations being (256 ±178) ng/ml (t=39.485, P<0.05).Complete ablation (CR) was found in 26 cases, ablation in the majority (PR) was found in 21 cases, 4 cases were found to be stable (SD), progress (PD) was found in 1 case, and the total effective rate was 90.4%.The 12 months survival rate was 92.3%.Conclusions TACE combined with CT guided percutaneous radiofrequency ablation is safe, effec-tive and minimally invasive in the treatment of large hepatocellular carcinoma.