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目的:研究高强度聚焦超声治疗邻近大血管肝癌的疗效及安全性。方法:对60例邻近大血管肝癌患者进行高强度聚焦超声治疗,治疗后检查治疗前甲胎蛋白(alpha-fetoprotein,AFP)>20μg/L患者AFP的变化。术后通过影像学(增强MRI)检查肿瘤消融情况、临近肿瘤大血管灌注情况。观察术后不良反应,并行临床随访。结果:60例患者均完成手术,42例术前AFP>20μg/L患者术前AFP为(614.1±130.9)μg/L,治疗1个月后为(277.8±59.2)μg/L,较术前明显下降(P=0.012)。术后1个月影像学检查结果提示,64个肿瘤病灶中完全消融的41个(64.1%),剩下的23个(35.9%)病灶消融率>50%;增强MRI静脉期检查邻近肝癌病灶大血管无灌注0例,部分灌注0例。不良反应以肝区疼痛、发热、转氨酶一过性升高为主,经对症处理后均好转;无肝破裂和腹腔内大出血等严重并发症。随访期间死亡26例(43.3%),1年、2年、3年、4年和5年的累积生存率分别为71.3%、53.2%、41.8%、33.4%和33.4%。结论:采用高强度聚焦超声治疗临近大血管的肝癌安全且有效,该方法对邻近病灶的大血管也是安全的。
Objective: To study the efficacy and safety of high-intensity focused ultrasound in the treatment of adjacent large-vessel hepatocellular carcinoma. Methods: Sixty cases of adjacent large vessel hepatocellular carcinoma (HCC) were treated by high intensity focused ultrasound. After treatment, the AFP levels in patients with alpha-fetoprotein (AFP)> 20 μg / L before treatment were examined. Postoperative imaging (enhanced MRI) examination of tumor ablation, adjacent to the tumor macrovascular perfusion. Adverse reactions were observed and followed up clinically. Results: The preoperative AFP was (614.1 ± 130.9) μg / L in 42 patients with preoperative AFP> 20 μg / L and (277.8 ± 59.2) μg / L after 1 month of treatment, respectively. Decreased significantly (P = 0.012). Imaging results at 1 month postoperatively indicated that 41 (64.1%) of 64 tumor lesions completely ablated and the remaining 23 (35.9%) had ablation rates> 50%. MRI enhanced venous phase examination of adjacent liver cancer lesions 0 cases of no vascular perfusion and 0 partial perfusion. Adverse reactions to the liver pain, fever, transient increase of transaminase-based, after symptomatic treatment were improved; no serious complications such as liver rupture and intra-abdominal hemorrhage. The cumulative survival rates during follow-up were 26 (43.3%), 71.3%, 53.2%, 41.8%, 33.4% and 33.4% at 1, 2, 3, 4 and 5 years, respectively. CONCLUSION: HIFU is a safe and effective method for the treatment of hepatocellular carcinoma adjacent to large vessels. This method is also safe for large vessels adjacent to the lesion.