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目的探讨射频消融(RFA)规范化治疗及综合措施对提高肝肿瘤疗效的应用价值。方法302例计476个肝脏恶性肿瘤行RFA治疗,应用规范化治疗方案及附加治疗方法,总结疗效。原发性肝癌(HCC)181例,282个癌灶,肿瘤大小平均4.2cm。肝转移癌(MLC)121例,194个癌灶,肿瘤大小平均3.9cm。根据肿瘤大小、形态及邻近膈肌、胆囊、胃肠等不同位置,采用相应的规范化方案及个体化方案相结合治疗;重视相邻重要结构区域的消融布针方法及操作技巧;应用辅助定位、局部注水、加强肿瘤血管消融等附加方法综合治疗。结果综合应用以上方法,RFA后1个月增强CT或超声造影显示肿瘤灭活率HCC为95.7%(270/282),MLC为94.8%(184/194);邻近肠管肿瘤为91.1%(51/56),邻近膈肌肿瘤为88.5%(69/78),邻近胆囊肿瘤为94.3%(49/52)。随访3～57个月,局部复发率HCC为10.3%(29/282),MLC为14.4%(28/194)。患者1年、2年、3年的生存率HCC为87.6%、67.4%、58.6%;其中50例Ⅰ～Ⅱ期肝癌的生存率分别为90.7%、85.9%、73.7%。MLC为87.4%、48.2%、25.3%。并发症占2.2%(13/583);分别为出血5例,采用局部消融、全身用药等处理措施;肠穿孔1例,对邻近肠管肿瘤采用治疗后延长禁食时间等措施进行预防。余7例为邻近脏器结构轻度损伤,无与射频治疗相关死亡。结论采用规范化RFA治疗方案及适宜的个体化治疗方案,重视附加方法的应用,有助于提高肝肿瘤灭活率;掌握主要并发症的类型及对应预防措施,是提高疗效及推广RFA治疗的重要环节。
Objective To investigate the application value of standardized therapy and comprehensive measures of radiofrequency ablation (RFA) to improve the therapeutic effect of liver tumors. Methods 302 cases of 476 liver malignancies underwent RFA treatment, the application of standardized treatment programs and additional treatment methods to summarize the efficacy. 181 cases of primary liver cancer (HCC), 282 foci of cancer, the average tumor size of 4.2cm. 121 cases of liver metastases (MLC), 194 foci of cancer, the average tumor size 3.9cm. According to tumor size, shape and adjacent to the diaphragm, gallbladder, gastrointestinal and other different locations, the use of the corresponding standardization programs and individualized programs combined treatment; attention to the adjacent important structure of the regional ablation cloth method and operating skills; application of auxiliary positioning, local Water injection, to strengthen the tumor vascular ablation and other additional methods of comprehensive treatment. Results Combined application of the above methods, enhanced CT or CEUS 1 month after RFA showed that the tumor inactivation rate was 95.7% (270/282), MLC was 94.8% (184/194), adjacent bowel tumor was 91.1% (51 / 56), 88.5% (69/78) of the adjacent diaphragm tumors and 94.3% (49/52) of the adjacent gallbladder tumors. The follow-up ranged from 3 to 57 months. The local recurrence rate was 10.3% (29/282) for HCC and 14.4% (28/194) for MLC. The 1-year, 2-year and 3-year survival rates of patients with HCC were 87.6%, 67.4% and 58.6%, respectively. The survival rates of 50 patients with stage I-II HCC were 90.7%, 85.9% and 73.7%, respectively. MLC was 87.4%, 48.2%, 25.3%. Complications accounted for 2.2% (13/583); bleeding were 5 cases, the use of local ablation, systemic medication and other measures; intestinal perforation in 1 case, the treatment of adjacent intestinal tumors to extend the fasting time after treatment measures such as prevention. The remaining 7 cases were mild injuries to the adjacent organs and no radiotherapy-related death. Conclusions The standardized RFA regimen and appropriate individualized treatment regimen emphasize the application of additional methods and help to improve the liver tumor inactivation rate. To master the types of major complications and the corresponding preventive measures is to improve the efficacy and promote the importance of RFA treatment Links.