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目的 探讨超声引导射频消融 (RFA)对肝脏恶性肿瘤的治疗效果。方法 对原发性肝癌 5 5例、肝转移癌 37例 ,计 92例、132个病灶行超声引导RFA治疗 ;肿瘤大小中位数为 3 .2cm(1.5～ 8.0cm)。89例经皮超声引导RFA术均在门诊进行 ,余 3例行术中超声引导下RFA治疗。采用螺旋CT增强检查及其他方法综合评价疗效。结果 1d或 1个月后增强CT检查 ,显示 12 0个病灶被完全灭活 ,有效率达90 .9% ,其中有 2 1例 (2 2 .8% )行第 2～ 4次RFA治疗。 1至 3个月后CT显示 85例 (6 8.5 % )肿瘤缩小。1例巨块型肝癌大出血 ,急诊手术中行RFA治疗止血成功。经 3～ 16个月随访 ,目前 89例存活 ,1例因手术、2例因合并食管静脉瘤出血死亡。较重并发症 3例 ,1例损伤肝被膜致出血 ,经RFA止血成功 ;1例肝功能指标异常加重 ,出现黄疸、腹水 ;另 1例肝管显著扩张 ,黄疸加重 ,行经皮肝胆管置管引流。结论 超声引导RFA对不能或不适宜手术切除的肝脏恶性肿瘤提供了有效的微创治疗手段 ,但选择适应证及重视操作方法仍是关键因素。RFA对肝肿瘤破裂出血可能为一局部止血的方法
Objective To investigate the effect of ultrasound-guided radiofrequency ablation (RFA) on liver malignancy. Methods Ultrasound-guided RFA was performed in 55 patients with primary liver cancer and 37 patients with metastatic liver cancer. 92 patients and 132 lesions were treated with ultrasound-guided RFA. The median tumor size was 3.2 cm (1.5 to 8.0 cm). 89 cases of percutaneous ultrasound-guided RFA were performed in the outpatient department. The remaining 3 cases underwent intraoperative ultrasound-guided RFA. Spiral CT enhanced examination and other methods to comprehensively evaluate the efficacy. Results After 1d or 1 month of enhanced CT examination, 120 lesions were completely inactivated with an effective rate of 90.9%, of which 21 patients (22.8%) received the second to fourth RFA treatment. From 1 to 3 months later, CT showed 85 cases (68.5 %) tumor shrinkage. In 1 case of massive hepatocellular carcinoma, hemostasis was successful in emergency surgery with RFA. After 3 to 16 months of follow-up, 89 cases are currently alive, 1 case died of surgery, 2 cases of bleeding due to combined esophageal varices. Heavier complications in 3 cases, 1 case of hemorrhage caused by damage to the liver capsule, and successful hemostasis by RFA; 1 case of abnormal hepatic function was aggravated with jaundice and ascites; another case of hepatic duct was significantly dilated, jaundice was aggravated, and percutaneous hepatobiliary tube placement was performed. drainage. Conclusion Ultrasound-guided RFA provides an effective minimally invasive treatment for liver malignancies that are either not suitable or not suitable for surgical resection, but the selection of indications and the emphasis on methods of operation are still key factors. RFA may be a method for local hemostasis of liver tumor rupture