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目的评估肝动脉化疗栓塞(TACE)联合同步DSA-CT引导下射频消融(RFA)治疗大肝癌(肿瘤最大直径≥5 cm)的安全性和疗效。方法 2010年1月~2012年3月21例原发性肝细胞癌患者接受同步联合治疗。术后定期进行影像学检查并复查甲胎蛋白,评估联合技术成功率、局部肿瘤治疗反应、无疾病复发时间、患者存活情况和技术相关并发症。结果技术成功率100%,无重要并发症发生。介入术后1个月复查,病灶完全缓解19例(19/21,90.48%)、部分缓解2例(2/21,9.52%)。肿瘤坏死以凝固性坏死为主。在局部灭活肿瘤方面,单结节型完全坏死率(17/17,100%)高于多结节性病灶(2/4,50.00%;P=0.034)。随访2~28个月,19例完全缓解者平均无疾病复发时间为(11.8±6.0)个月。21例患者6、12、18个月生存率均为100%。结论 TACE联合同步DSA-CT引导下RFA治疗大肝癌安全、有效。局部肿瘤灭活方面,单结节型病灶优于多结节病灶。
Objective To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) and simultaneous radiofrequency ablation (RFA) guided by simultaneous DSA-CT in the treatment of large hepatocellular carcinoma (maximum tumor diameter≥5 cm). Methods From January 2010 to March 2012, 21 patients with primary hepatocellular carcinoma underwent concurrent combination therapy. Regular postoperative imaging and alpha-fetoprotein review were performed to assess the success rate of the combination technique, local tumor response, time to disease-free survival, patient survival, and technology-related complications. Results Technical success rate of 100%, no major complications. One month after the intervention, 19 cases (19/21, 90.48%) had complete remission and 2 cases (2/21, 9.52%) had partial remission. Tumor necrosis mainly coagulation necrosis. In locally inactivated tumors, the single nodular complete necrosis rate (17/17, 100%) was higher than in multinodular lesions (2/4, 50.00%; P = 0.034). During the follow-up of 2 to 28 months, the average time to disease-free relapse in 19 patients with complete remission was (11.8 ± 6.0) months. The survival rates at 6, 12 and 18 months in all 21 patients were 100%. Conclusion TACE combined with simultaneous DSA-CT guided RFA in the treatment of large hepatocellular carcinoma is safe and effective. Local tumor inactivation, single nodular lesions better than multiple nodular lesions.