摘要
目的总结肝癌射频消融（RFA）的临床经验并探讨评价RFA疗效的方法。方法对49例肝癌病人进行了统一方案的RFA治疗，其中男43例，女6例；年龄39～72岁，平均（56．4±9．3）岁。肿瘤直径1．5～10cm，其中≤3cm16例，3．1--5cm15例，〉5cm18例。按肝功能Child—Pugh分级，A级41例，B级8例。病理诊断为肝细胞癌44例，胆管细胞性肝癌5例。采用RITA射频消融肿瘤治疗系统（RF-1500）行RFA。在RFA后344周常规行CT及TACE，以评价肝癌RFA的效果及巩固疗效。结果全部病例RFA术后恢复顺利，总体1、2、3年生存率为77．5％、56．5％和44．0％，肝癌RFA后3～4周，AFP阳性（≥25μg／L）者转阴率62．9％（22／35）。改进的肝癌RFA方法可对直径5cm以下的肿瘤进行比较彻底的消融，≤5cm者1、2、3年生存率为100％、79．6％和61．9％。将肝癌消融近期疗效分为3个级别，RFA术后获得根治性消融（19例）、亚根治消融（9例）、姑息性消融（21例）者2年生存率分别为85．7％、60．0％和24．3%。结论肝癌RFA相当于从机能上切除了肿瘤，肝癌消融近期疗效三级分类法可以比较客观地评价RFA的效果，以指导辅助治疗的选择。
Objective To summarize the experience in treatment of unresectable primary liver cancer （PLC） with radiofrequency ablation （RFA） and evaluate the outcome. Methods Over a 3 year period, 49 consecutive patients with solitary or multinodular PLC （Child-Pugh class A or B） underwent RFA. Histopathologic types were of hepatocellular carcinoma in 43 cases and of cholangio-carcinoma in 6. The tumor size was 1.5-10.0 cm. RFA was performed by a RITA expandable electrode device（RF-1500） followed by TACE administration 3--4 weeks later. Local efficacy was evaluated with computed tomography （CT） performed at an average of 4 weeks after RFA treatment and then during follow-up. Results There were no severe complications after RFA in all the patients. The total 1, 2 and 3-year survival rates were 77.5%, 56.5% and 44.0%, respectively. Tumors no more than 5cm in diameter could be ablated inside out. The 1, 2 and 3-year survival rates were 100%, 79.6%, 61.9%, respectively. The treatment response of RFA was assessed as curative ablation （complete tumor ablation with 0.5--1 cm ablative margin） in 19 cases, sub-curative ablation （complete tumor ablation with less than 0. 5 cm ablative margin） in 9 cases,non-curative （noncomplete） ablation in 21 cases. The 2-year survival rate was 85.7%, 60.0% and 24.3%, respectively, in patients with different types of response. Conclusion RFA has similar effect as resection of PLC on small tumors. The classification method for the evaluation of RFA display the results in 3 grades, and it is useful for the selection of adjuvant therapy.
出处
《中华肝胆外科杂志》
CAS
CSCD
2008年第12期844-847,共4页
Chinese Journal of Hepatobiliary Surgery
基金
基金项目：国家自然科学基金（项目批准号：30772122）
关键词
癌
肝细胞
射频消融(RFA)
生存率
治疗效果
Carcinoma,hepatocellular
Radiofrequency ablation
Survival rate
Treatment outcome
