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目的 改进微波消融技术治疗肝癌 ,评价近期临床效果。方法 自 2 0 0 3年 8月至 2 0 0 4年 7月 ,利用低杆温微波电极在经皮肝癌消融治疗中无皮肤腹壁组织烧伤之虞的优点 ,改进常规的消融方法 ,将单次能量输出增加至 (70～ 80 )W× (2 0～ 2 5 )min ,对直径 >5cm的结节插入 3～ 4针 ,每个病灶治疗 1次。该研究运用该技术在超声引导下经皮消融治疗了 6 6例肝癌病人 10 5个肿瘤结节 ,观察组织消融范围、肿瘤完全消融率、局部复发率和并发症发生率。结果 增强CT或MRI扫描显示单次能量输出造成的组织消融范围可达到 (3 5～ 4 0 )cm×(4 5～ 5 0 )cm。肿瘤经 1次治疗的完全消融率为 92 4 % (97/ 10 5 )。直径≤ 3cm、>3cm和 >5cm结节的完全消融率分别为 94 0 (6 3/ 6 7)、88 9% (2 4 / 2 7)和 90 9% (10 / 11) ,3组间以及每两组间差异无显著性 (P值均大于0 0 5 )。在 1 0～ 12 4个月随访期间内 3个病灶 (2 9% )局部复发。无与治疗相关的死亡 ,并发症发生率 15 2 %(10 / 6 6 )。结论 改良的微波消融技术安全、有效 ,通过增加单次能量输出能够扩大组织消融范围 ,提高局部疗效 ,减少治疗次数和穿刺针数 ,降低治疗成本。
Objective To improve the microwave ablation technique in the treatment of liver cancer and evaluate the clinical effect in the near future. Methods From August 2003 to July 2004, using the advantages of low temperature microwave electrodes in the treatment of percutaneous liver cancer ablation without the risk of burns of the skin and abdominal wall tissue, to improve the conventional ablation method, a single The energy output was increased to (70-80) W × (20-25) min, and 3 to 4 needles were inserted for nodules> 5 cm in diameter, one for each lesion. The study used this technique to treat 105 tumor nodules in 6 6 patients with HCC via percutaneous ablation guided by ultrasound. The extent of tissue ablation, complete tumor ablation rate, local recurrence rate and complication rate were observed. Results Enhanced CT or MRI scan showed that the range of tissue ablation caused by single energy output could reach (35 ~ 40 cm) (45 ~ 50 cm). The complete ablation rate of tumors after one treatment was 92 4% (97/105). The complete ablation rates of nodules ≤ 3 cm,> 3 cm and> 5 cm were 94 0 (6 3/67), 88 9% (2 4/2 7) and 90 9% (10/11), respectively There was no significant difference between the two groups (P> 0.05). Three lesions (29%) were locally recurred during the follow-up period of 10 to 12 months. No treatment-related deaths, with a complication rate of 15 2% (10/6 6). Conclusion The improved microwave ablation technique is safe and effective. By adding a single energy output, the scope of tissue ablation can be expanded, the local curative effect can be improved, the number of treatments and the number of puncturing needles can be reduced, and the treatment cost can be reduced.