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目的 探讨经皮射频消融联合肝动脉、门静脉栓塞化疗在不能手术切除的肝癌治疗中的价值。方法 从 2 0 0 0年 9月至 2 0 0 3年 3月 ,佛山市第一人民医院对符合条件的 2 0例原发性和转移性肝癌病人先行肝动脉栓塞化疗 (TACE)和门静脉栓塞化疗 (PVCE) ,再在B超引导下经皮射频消融 (PRFA)治疗 ;另 2 0例肝癌病人直接给予PRFA治疗。治疗后定期复查B超、CT或MRI。确定肿瘤是否坏死或缩小 ,有无复发转移灶 ,肿瘤特异指标的变化。Kaplan Meier法计算无瘤生存率和累积生存率。结果 对于转移性肝癌 ,联合治疗组CEA阳性者治疗转阴率 5 0 % (2 / 4 ) ,单纯治疗组CEA阳性者治疗后转阴率 2 5 % (1/ 4 ) ,差异有显著意义。对于原发性肝癌或复发肝癌 ,联合治疗组AFP阳性者治疗后转阴率 6 2 5 % (5 / 8) ,单纯治疗组AFP阳性者治疗后转阴率30 % (3/ 10 ) ,差异有显著意义。肿瘤完全凝固坏死率 :单纯治疗组对于 <3cm瘤灶为 10 0 % (17/ 17) ,3～ 5cm为5 5 % (5 / 9) ,>5cm为 2 0 % (1/ 5 ) ;而联合治疗组 <3cm瘤灶为 10 0 % (19/ 19) ,3～ 5cm为 75 % (3/ 4 ) ,>5cm为4 0 % (2 / 5 )。肿瘤缩小率为 70 % (14 / 2 0 ) ,门静脉癌栓消失率为 2 5 % (1/ 4 ) ,缩小率为 5 0 % (2 / 4 )。肝内复发转移时间明显延长。联合治疗组
Objective To investigate the value of percutaneous radiofrequency ablation combined with hepatic artery and portal vein chemoembolization in the treatment of unresectable liver cancer. Methods From September 2000 to March 2003, Foshan First People’s Hospital of China, 20 eligible cases of primary and metastatic liver cancer patients undergoing hepatic arterial chemoembolization (TACE) and portal vein embolization Chemotherapy (PVCE), followed by B ultrasound guided percutaneous radiofrequency ablation (PRFA) treatment; the other 20 patients with liver cancer were given PRFA treatment. After treatment regularly review B-, CT or MRI. Determine whether the tumor necrosis or shrinkage, with or without recurrence of metastases, tumor-specific changes. Kaplan-Meier method to calculate the free survival rate and cumulative survival rate. Results For the patients with metastatic liver cancer, the CEA positive rate in treatment group was 50% (2/4), while that in CEA - positive group was 25% (1/4) after treatment. The difference was significant. For primary hepatocellular carcinoma or recurrent hepatocellular carcinoma, the AFP positive rate in the combined treatment group was 62.5% (5/8) after treatment, while that in the AFP-positive group was 30% (3/10) after treatment, the difference was statistically significant Have significant meaning The rate of complete tumor necrosis was 100% (17/17) for 3 cm tumor, 5 5% (5/9) for 3 ~ 5 cm, and 20% (1/5) for> 5 cm; The combined treatment group had a tumor size of 10% (19/19) at 3cm, 75% (3/4) at 3 ~ 5cm and 40% (2/5) at> 5cm. The tumor shrinkage rate was 70% (14/20), portal vein tumor thrombus disappearance rate was 25% (1/4), and the reduction rate was 50% (2/4). Liver recurrence and metastasis significantly longer time. Combination therapy group