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目的分析超声引导经皮微波消融(MWA)治疗肝细胞肝癌(HCC)的疗效。方法应用超声引导下经皮MWA技术治疗HCC共53人,88结节,直径为1.0～8.0cm,平均2.9±1.2cm。观察局部疗效、局部与远处复发率及生存率。所有病例均签署知情同意书。结果判断局部疗效的完全消融率(CA)为88.6%(78/88),其中肿瘤直径≤3.0cm、3.1～5.0cm及>5.0cm结节的CA率分别为96.4%(53/55)、82.6%(19/23)和60.0%(6/10)(直径≤3.0cm与其它两组间P<0.05.直径>3.0cm的两组间P>0.05)。局部复发率为24.4%(19/78),肝内远处复发与肝外转移率分别为33.3%(15/45)和17.8%(8/45)。随访时间为2～37个月,平均15.1±10.4个月。随访期间生存27例,死亡26例。6个月、1、2及3年的累积生存率分别为86.4%、64.9%、45.3%和17.6%,平均生存期21.2个月,中位生存期22.0个月。结论经皮MWA治疗的局部灭瘤效果满意,能够改善远期疗效。但需要进一步改进治疗技术,必要时应合用其他治疗方法。
Objective To analyze the curative effect of ultrasound guided percutaneous microwave ablation (MWA) on hepatocellular carcinoma (HCC). Methods 53 cases of HCC were treated with ultrasound-guided percutaneous MWA technique, with 88 nodules and 1.0 ~ 8.0 cm in diameter with an average of 2.9 ± 1.2 cm. To observe the local efficacy, local and distant recurrence rate and survival rate. Informed consent was signed in all cases. Results The complete ablation rate (CA) of local curative effect was 88.6% (78/88). The CA rates of tumor with diameter ≤3.0cm, 3.1 ~ 5.0cm and> 5.0cm were 96.4% (53/55) 82.6% (19/23) and 60.0% (6/10) (P <0.05 for diameter ≤3.0cm and P> 0.05 for both groups with diameter> 3.0cm). The local recurrence rate was 24.4% (19/78). The distant recurrence and extrahepatic metastasis in the liver were 33.3% (15/45) and 17.8% (8/45) respectively. Follow-up time was 2 to 37 months, with an average of 15.1 ± 10.4 months. During follow-up, 27 cases were alive and 26 died. The cumulative survival rates at 6 months, 1, 2, and 3 years were 86.4%, 64.9%, 45.3% and 17.6%, respectively. The mean survival time was 21.2 months and the median survival time was 22.0 months. Conclusion The results of percutaneous MWA treatment are satisfactory and the long-term curative effect can be improved. However, there is a need for further improvement of treatment techniques and, if necessary, other treatment options.