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目的:探讨经肝而非经肺的CT引导射频消融(CT-guided radiofrequency ablation,CT-RFA)治疗膈项部肝脏恶性肿瘤的技术路线、临床疗效和安全性。方法:对2003年9月-2012年10月本科收治的50例原发性或转移性肝癌患者的59个膈顶病灶进行CT-RFA治疗的临床资料进行回顾性分析。分析和总结CT-RFA治疗膈顶部肝脏恶性肿瘤的技术路线,并观察疗效和安全性。结果:本研究应用“立方体”模型,建立三维定向CT-RFA治疗膈顶部肝癌的穿刺路径。59个膈顶病灶的RFA治疗成功率和完全消融率分别为94.92%(56/59)和84.75%(50/59)。完全消融病灶患者的中位局部无复发时间为12.05个月,其中原发性肝癌患者为14.23个月,转移性肝癌患者为8.07个月,差异有统计学意义(P=0.037)。3例患者在RFA术后发生严重并发症,经对症治疗后好转。多因素分析结果显示,病灶大小是局部无复发生存时间的独立相关因素(P=0.028)。结论:经肝而非经肺的CT-RFA治疗膈顶部肝癌是一种安全而有效的治疗方法。肿瘤大小是局部无复发生存时间的独立相关因素。
Objective: To explore the technical route, clinical efficacy and safety of CT-guided radiofrequency ablation (CT-RFA) in the treatment of hepatic malignancies in the diaphragmatic part. Methods: The clinical data of CT-RFA in 59 cases of topographic and transseptal hepatocellular carcinoma from September 2003 to October 2012 in 50 patients with primary or metastatic liver cancer were analyzed retrospectively. To analyze and summarize the technical route of CT-RFA for the treatment of malignant tumors of the top of the diaphragm, and to observe the curative effect and safety. Results: In this study, the “Cube” model was used to establish the three-dimensional CT-RFA for the puncture of hepatocellular carcinoma at the diaphragm. The success rate and complete ablation rate of RFA in 59 cases of top of diaphragm were 94.92% (56/59) and 84.75% (50/59), respectively. The median time to non-recurrence was 12.05 months in patients with complete ablation, including 14.23 months in patients with primary liver cancer and 8.07 months in patients with metastatic HCC, the difference was statistically significant (P = 0.037). Three patients experienced severe complications after RFA and were improved after symptomatic treatment. Multivariate analysis showed that the size of the lesion was an independent and independent factor for local recurrence-free survival (P = 0.028). Conclusions: Transhepatic CT-RFA for the treatment of topical hepatocellular carcinoma is a safe and effective treatment. Tumor size was independently associated with local recurrence-free survival.