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目的 探讨对于位于第一肝门区的小肝癌行B超引导经皮肝穿刺射频消融 (PRFA)治疗的可行性、疗效和应注意的问题。方法 2 0 0 0年 4月至 2 0 0 2年 10月选择肿瘤位于第一肝门区、≤ 5cm、病理或临床证实为原发性或继发性肝癌的 2 1例患者进行PRFA治疗。治疗前甲胎蛋白 (AFP)阳性者治疗后定期复查AFP。治疗后 1个月复查MRI或CT确定肿瘤是否完全坏死 ,以后每 3个月定期复查。Kaplan Meier法计算“无瘤”生存率和累积生存率。结果 AFP转阴率约为 78% ,MRI或CT显示第一肝门区肿瘤完全凝固坏死率为 90 5 % (19/ 2 1)。 0 5、1、1 5、2年无原位复发生存率均为94 7% ;0 5、1、1 5、2年无“瘤旁复发”生存率分别为 90 0 %、77 1%、77 1%和 77 1% ;0 5、1、1 5、2年总生存率分别为 89 2 %、82 8%、82 8%和 5 5 2 %。胆管狭窄发生率为 4 8%。结论 第一肝门区小肝癌并非PRFA治疗的禁忌证 ,只要治疗时穿刺点选择恰当、穿刺路径合理、超声监测下电极展开确切、热凝范围控制恰当 ,对于第一肝门区小肝癌PRFA是一种行之有效的治疗方法。
Objective To investigate the feasibility, efficacy and issues to be addressed in the treatment of small hepatocellular carcinoma (HCC) located in the first hilar region with ultrasound-guided percutaneous transhepatic radiofrequency catheter ablation (PRFA). Methods From April 2000 to October 2002, 21 patients with tumors located in the first hilar region, ≤5 cm and pathologically or clinically confirmed as primary or secondary liver cancer were selected for PRFA. AFP pre-treatment positive after treatment regularly review AFP. One month after treatment, MRI or CT should be performed to determine whether the tumor is completely necrotic or not, and to be regularly reviewed every 3 months thereafter. Kaplan-Meier method to calculate “tumor-free” survival rate and cumulative survival rate. Results The negative rate of AFP was 78%. The complete coagulation necrosis rate of the first hilar region was 90.5% (19/2 1) by MRI or CT. 0 5,1,1 5, 2 years without in situ recurrence survival rates were 94 7%; 0 5,1,1 5, 2 years without “tumor recurrence” survival rates were 90 0%, 77 1%, respectively, The overall 2-year survival rates were 89 2%, 82 8%, 82 8% and 52 2% respectively at 77.1% and 77.1%. The incidence of biliary stricture was 48%. Conclusions The first hilar hepatocellular carcinoma is not contraindicated in the treatment of PRFA. As long as the puncture point is properly selected and the puncture path is reasonable, the electrodes under the ultrasonic monitoring are exactly opened and the proper range of the thermocoagulation is controlled. For the first hilar area, An effective method of treatment.