微创医学

目的探讨CT导引下射频消融(RFA)联合肝动脉化疗性栓塞(TACE)综合治疗肝癌的效果。方法 45例肝癌病例,肿瘤直径均<5cm。20例行化疗性栓塞后2-4周行射频消融术,25例行单纯肝动脉化疗性栓塞。治疗效果评价均采用CT或MR平扫、增强扫描和AFP指标及临床随访,评估两种方法肿瘤坏死程度、AFP指标变化、肿瘤初次复发率及一年生存率。结果 20例TACE+RFA术后CT、MR检查16例完全坏死,3例不完全坏死,1例部分坏死;15例患者AFP转阴或明显下降(70%以上);临床随访,累计生存率>1年(95.0%)、>2年(70.0%)。25单纯TACE术后CT、MR检查5例完全坏死,10例不完全坏死,10例部分坏死;9例患者AFP转阴或下降(<50%),25例临床随访,累计生存率>1年(80.0%)、>2年(52.0%)。全部患者术后右上腹不同程度疼痛,大部分患者术后1～3d发热,1例并发肝包膜下少量出血,所有病例无气胸、大出血及胆瘘等。结论 CT导引下射频消融(RFA)联合肝动脉化疗性栓塞(TACE)是安全、有效的治疗方法,疗效优于单纯化疗性栓塞(TACE)。

Objective To explore the effect of CT-guided radiofrequency ablation ( ＲFA) in combination with transcatheter arterial chemotherapy embolism( TACE) in the treatment of hepatocellular carcinoma ( HCC) ． Method 45 HCC patients with diameter ＜ 5 cm were enrolled，among which，20 were performed with ＲFA 2 to 4 weeks after TACE( Combination Group) ，and 25 were performed with only TACE( TACE Group) ． Therapeutic effect index included tumor necrosis degree，AFP index change，tumor recurrence rate，and the first year survival rate evaluated by CT or MＲ flat esau， enhancement scanning，AFP index，and clinical follow-up．Ｒesults In the Combination Group ， there were 16 cases of complete necrosis，3 cases incomplete necrosis，and 1 case part necrosis evaluated by CT and MＲ; 15 patients were AFP negative or decreased for more than 70%; cumulative survival rate ＞ 1 year was 95． 0%，and cumulative survival rate ＞ 2 years was 70． 0%． As in the TACE Group，there were 5 cases of complete necrosis，10 cases incomplete necrosis， and 10 case part necrosis evaluated by CT and MＲ; 9 patients were AFP negative or decreased for more than 50%; cumulative survival rate ＞ 1 year was 80． 0%，and cumulative survival rate ＞ 2 years was 52． 0%． All patients was reported with different degree of pain，most of the patientswith postoperative 1-3 d fever，1 case of small amount of bleeding under liver capsule，no pneumothorax cases，hemorrhage and biliary fistula was recorded． Compared with TACE Group，the Combination Group has a higher tumor necrosis degree，less first recurrence rate，higher 1 year survival rate，all with statistical significance ( P ＜ 0． 05) ． Conclusion CT-guided ＲFA in combination with TACE is safe and effective，and has a superior effect to pure TACE in the treatment of HCC．