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目的 探讨经皮肝穿刺射频热凝治疗肝癌的意义、适应证和疗效评价标准。 方法1999年 10月～ 2 0 0 0年 10月 ,10 0例肝脏恶性肿瘤患者进行了B超引导经皮肝穿刺射频热凝治疗。患者治疗后每个月进行血清肿瘤标记物检测、B超检查 ,治疗后 1个月复查MRI。 结果 患者肝功能ChildA级 6 7例 ,ChildB级 2 9例 ,ChildC级 4例。原发性肝癌 76例 ,转移性肝癌 2 4例。小肝癌 (未手术 ,肿瘤直径≤ 5cm)甲胎蛋白阳性者治疗后甲胎蛋白转阴占 75 0 % (2 1 2 8) ,明显下降占 2 1 4% (6 2 8)。B超复查肿瘤缩小、MRI或CT提示≤ 5cm肿瘤完全凝固性坏死率 85 9% (6 1 71)。 结论 经皮肝穿刺射频热凝 (PRFA)作为肿瘤透热治疗的一种方法 ,对于小肝癌尤其是无手术指征 ,或有手术指征但位于肝中央区、临近腔静脉或肝门区的小肝癌 ,是一种微创、时间短、安全方便、疗效可靠的新方法。对于大肝癌 ,PRFA可与肝动脉介入化疗栓塞联合应用 ,提高疗效。
Objective To explore the significance, indications and evaluation criteria of percutaneous transhepatic radiofrequency thermocoagulation for liver cancer. Methods From October 1999 to October 2000, 100 patients with hepatic malignancies underwent percutaneous transhepatic radiofrequency thermocoagulation. Serum tumor markers and B-ultrasound were performed monthly after treatment, and MRI was reviewed 1 month after treatment. Results There were 67 cases of ChildA in liver function, 29 cases in Child B, and 4 cases in ChildC. There were 76 cases of primary liver cancer and 24 cases of metastatic liver cancer. In the small-hepatic cancer patients (without surgery, tumor diameter ≤ 5cm), alpha-fetoprotein-positive patients accounted for 75.0 % (2128) after treatment, with a significant decrease accounting for 21.4 % (62.8). The B-mode ultrasonography revealed tumor shrinkage, MRI, or CT findings with a total coagulation necrosis rate of ≤ 5 cm (85 9%) (6 1 71). Conclusion Percutaneous radiofrequency thermocoagulation (PRFA) is a method for tumor diathermy. It is especially indicated for small hepatocellular carcinoma with no indication of surgery, or indication for surgery, but located in the central area of the liver, adjacent vena cava or portal area. Small liver cancer is a new method that is minimally invasive, short in time, safe, convenient and reliable. For large HCC, PRFA can be combined with hepatic artery interventional chemoembolization to improve efficacy.