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目的观察与分析经皮射频消融术(RFA)治疗原发性肝癌的临床疗效和并发症。方法从2000年1月~2007年6月,B超引导下对256例原发性肝癌患者行354例次RFA,治疗前后行AFP、B超或CT检查,治疗后随访,最长随访5年以上。结果2例治疗后24h内出现严重并发症而死亡。RFA术后并发症有:感染、发热223例次(62.99%),肝细胞明显损害117例次(33.05%),黄疸明显加重67例次(18.92%),血性腹水14例次(3.95%),气胸3例次(0.84%),消化道出血2例次(0.56%)。治疗后随访到6月者187例,AFP下降50%者129例(68.98%),死亡23例,存活164例(87.70%)。随访1年者129例,AFP下降50%者67例(51.93%),死亡37例,存活92例(71.31%)。随访3年者83例,AFP下降50%者28例(37.73%),死亡51例,存活32例(38.55%)。随访5年者56例,AFP下降50%者12例(21.42%),死亡44例,存活12例(21.42%)。肝脏肿瘤个数少和病灶体积小或者肝功Child-Pugh分级较好的患者生存率高。结论RFA具有简单、微创、安全、有效和反复治疗等优点,尤其对于无手术指征及TACE风险较大者,具有更重要的意义。当肿瘤<5cm尤其是单个病灶或肝功Child-Pugh分级较好时效果更加明显。但并发症较多,长期疗效有待提高。
Objective To observe and analyze the clinical efficacy and complications of percutaneous radiofrequency ablation (RFA) in the treatment of primary liver cancer. Methods From January 2000 to June 2007, 354 cases of RFA were performed in 256 patients with primary liver cancer under ultrasound guidance. AFP, B-ultrasound or CT was performed before and after treatment. The patients were followed up for 5 years the above. Results Two patients died of severe complications within 24 hours after treatment. Postoperative complications of RFA included 223 cases (62.99%) of infection and fever, 117 cases of hepatocellular damage (33.05%), 67 cases of jaundice (18.92%) and 14 cases of bloody ascites (3.95%), 3 cases of pneumothorax (0.84%) and 2 cases of gastrointestinal bleeding (0.56%). A total of 187 patients (87.70%) survived in 187 patients who were followed up until June after treatment. 129 cases (68.98%) were AFP decreased by 50%, 23 died. A total of 129 cases were followed up for 1 year. AFP decreased by 50% in 67 cases (51.93%), 37 died and 92 survived (71.31%). 83 cases were followed up for 3 years. There were 28 cases (37.73%) with 50% reduction in AFP, 51 cases died and 32 cases (38.55%) survived. 56 cases were followed up for 5 years. There were 12 cases (21.42%) with 50% reduction of AFP, 44 cases died and 12 cases (21.42%) survived. High survival rates were found in patients with fewer liver tumors and smaller lesions or better Child-Pugh grading. Conclusion RFA has the advantages of simple, minimally invasive, safe, effective and repeated treatment, especially for those who have no indications for surgery and have a higher risk of TACE. When the tumor <5cm, especially a single lesion or liver function better Child-Pugh classification effect is more obvious. However, more complications, long-term efficacy needs to be improved.