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目的 评估经皮热消融对不能再手术切除的复发性肝细胞癌 (RHCC)的临床治疗价值。方法 1997年 10月至 2 0 0 2年 12月中山大学附属第一医院采用超声引导经皮射频消融 (RFA)或微波消融 (MWA)治疗不能再手术切除的RHCC ,35例共 87个肿瘤结节 ,直径 0 9～ 6 4cm。观察局部疗效、治疗并发症和远期生存情况。结果 肿瘤完全消融率 (完全灭活率 )为 97 7% (85 / 87) ,其中直径≤ 3cm结节为 98 6 %、3cm以上者为 94 1%。无治疗死亡 ,并发症发生率为 2 9% (1/ 35 )。平均随访 (2 7 7± 16 7)个月 ,肿瘤局部复发率为 10 6 % (9/ 85 ) ;远处复发率为 91 4 % (32 / 35 ) ,其中 15例 (4 7% )发生多次远处复发。经对局部复发和远处复发者的反复治疗 ,首次消融后 1、3、5年累积生存率分别为 77 1%、4 6 2 %和 14 9% ,中位生存期为 2 5 2个月 ;首次肝切除后 1、3、5及 10年生存率分别达到 96 2 %、6 4 1%、4 7 7%和 14 1% ,中位生存期为 5 7 0个月。结论 经皮热消融技术局部灭瘤效果满意 ,创伤微小且便于反复施行 ,能够显著改善病人的远期生存 ,是不能再切除的RHCC有效治疗手段。
Objective To evaluate the clinical value of percutaneous thermal ablation for recurrent hepatocellular carcinoma (RHCC) that can not be surgically resected. METHODS: From October 1997 to December 2002, the First Affiliated Hospital of Sun Yat-sen University underwent ultrasound-guided percutaneous radiofrequency ablation (RFA) or microwave ablation (MWA) to treat unresectable RHCC. A total of 87 tumor nodes Festival, diameter 0 9 ~ 6 4cm. Observation of local efficacy, treatment of complications and long-term survival. Results The rate of complete tumor ablation (complete inactivation rate) was 97.7% (85/87). Among them, 98.6% of nodules ≤ 3 cm in diameter and 94.1% of those with more than 3 cm in diameter. No treatment died, the complication rate was 29% (1/35). The local recurrence rate was 10 6% (9/85) in the mean follow-up (277 ± 167) months and distant recurrence rate was 91 4% (32/35) in 15 (47%) cases Repeatedly distant recurrence. The cumulative survival rates at 1, 3 and 5 years after first ablation were 77 1%, 46 2% and 14 9%, respectively, after repeated treatment of local recurrence and distant recurrence. The median survival time was 25 2 months The 1,3,5 and 10 year survival rates after first hepatectomy were 96 2%, 64 1%, 47 7% and 14 1%, respectively. The median survival time was 57 0 months. Conclusions The percutaneous thermal ablation technique is satisfactory in local tumor-killing, with minimal trauma and repeated operation. It can significantly improve the long-term survival of patients and is an effective treatment for unresectable RHCC.