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目的:研究胃癌肝转移经肝动脉化疗栓塞联合射频消融治疗的临床意义。方法:选择胃癌肝转移灶小于4处,最大直径不超过4cm的患者23名。全组患者接受胃癌D2根治性切除及超声引导下射频消融治疗,其中15名患者术前接受了肝动脉化疗栓塞治疗。术后化疗采用以氟尿嘧啶及奥沙利铂为基础的方案。结果:本研究组未发生严重并发症,无病复发生存时间和总生存时间分别为366天和505天,5例患者获得无复发长期生存。多因素分析表明,N分期、转移癌的分布及是否接受肝动脉化疗栓塞治疗为独立预后因子。分层分析提示,术前肝动脉化疗栓塞治疗对多叶肝转移组疗效为优。结论:胃癌肝转移孤立或少数较小转移灶病例通过根治性手术、射频消融、肝动脉化疗栓塞术及术后化疗联合方案能够提高疗效,对部分患者可能获得长期生存的治疗成绩。
Objective: To study the clinical significance of hepatic metastasis of gastric cancer treated with transcatheter arterial chemoembolization combined with radiofrequency catheter ablation. METHODS: Twenty-three patients with less than 4 liver metastases in gastric cancer and no more than 4 cm in diameter were selected. All patients underwent radical resection of D2 gastric cancer and ultrasound-guided radiofrequency ablation, of which 15 patients received preoperative hepatic artery chemoembolization. Postoperative chemotherapy with fluorouracil and oxaliplatin-based programs. Results: There was no serious complication in this study group. The disease-free survival time and total survival time were 366 days and 505 days respectively. Five patients had long-term recurrence-free survival. Multivariate analysis showed that the distribution of N staging, metastatic carcinoma and whether to receive transcatheter arterial chemoembolization were independent prognostic factors. Hierarchical analysis suggests that preoperative hepatic arterial chemoembolization is superior to multiyear hepatic metastasis. CONCLUSIONS: In isolated gastric cancer patients or in a few small metastatic cases, curative effect can be improved by radical surgery, radiofrequency ablation, transcatheter arterial chemoembolization and postoperative chemotherapy, and some patients may obtain long-term survival results.