摘要
目的 评价经皮冷消融联合经皮酒精注射 (PEI)治疗不能切除的肝细胞癌 (HCC)的有效性和安全性。方法 6 5例HCC患者共 10 5个肿瘤块接受经皮冷消融治疗。冷消融采用Cryocare系统 ,氩气作为冷却剂 ,共给予 2次冷却 复温循环 ,每次冷却时冷冻刀顶端温度为 - 180℃。其中 36例瘤块直径大于 6cm的患者 ,在冷消融治疗后 1～ 2周接受PEI治疗 ,每周 1次 ,连续 4～ 6次。结果 在平均随访期为 16个月 (5～ 2 1个月 )内 ,32例 (4 9.2 % )无瘤生存 ,2 2例 (33.8% )生存但有肿瘤复发 ,其中 2例骨转移 ,3例肺转移 ,其余 17例为肝内复发 ,但仅有 3例是原先冷消融部位复发。在随访 1年以上的 4 1例患者中 ,有 32例 (78% )迄今仍生存 ,包括无复发和有复发的病例。 8例 (12 .3% )死于肿瘤复发 ,3例(4 .6 % )死于非癌性原因。有CT复查资料的 4 3例中 ,38例 (88.4 % )显示肿瘤缩小。冷消融治疗后 2 2例行瘤块活检 ,除 1例外 ,均显示为坏死性疤痕组织。冷消融治疗前血清甲胎蛋白 (AFP)升高的病例中 ,91.3%在治疗后 3～ 6个月内AFP下降至正常或接近正常。冷消融并发症包括 1例发生肝包膜开裂 ,4例发生一过性血小板降低 ,2例发生无症状性右侧胸腔积液 ,2例在原先冷消融部位发生肝脓肿。结论 经皮冷消融为不能手术切除的HCC?
Objective To evaluate the effectiveness and safety of percutaneous hepatic cryoablation combined with percutaneous ethanol injection(PEI) for patients with hepatocellular carcinoma (HCC) unsuitable for surgical resection. Methods One hundred and five masses in 65 HCC patients underwent percutaneous hepatic cryoablation. The cryoablation was performed using Argon gas as a cryogen in the Cryocare System. Two freeze thaw cycles were performed, each reaching a temperature of -180 ℃ at the tip of the probe. PEI was given 1 or 2 weeks after cryoablation and then once a week for 4 6 weeks in 36 patients with tumor mass larger than 6 cm in diameter. Absolute alcohol(100%) was slowly injected into periphery zone of cancerous tissues in liver. Results During average 16 months follow up duration (ranging 5 to 21 months), 32 patients(49.2%) were alive without tumors, and 22 patients (33.8%) were alive with tumor recurrence: two had bone metastases, three lung metastases and the remaining 17 tumor recurrences in the liver, of whom only 3 developed at a cryoalbation site. Among 41 patients who had been followed up more than one year, there were 32(78%) patients who were alive with or without tumor recurrence. Eight patients (12.3%) died of tumor recurrence. Three patients(4.6%) died of noncancer related causes. Among 43 patients who had undergone CT scan, 38 ( 88.4% ) had a shrinkage of tumor mass. Among 22 patients who had received biopsies of cryoablated tumor mass, all but one biopsy showed necrotic or scar tissues. Serum AFP in 91.3% of the patients whose serum AFP had increased before cryoablation returned to normal or nearly normal levels during postoperative 3 6 months. Complications of cryoablation included liver capsular cracking in one patient, transient thrombocytopenia in 4 patients and asymptomatic right sided pleural effusions in 2 patients. Two patients developed liver abscess at the previous cryoablation sites after postoperative 2 and 4 months respectively and recovered after the treatment wi
出处
《中华消化杂志》
CAS
CSCD
北大核心
2003年第9期544-547,共4页
Chinese Journal of Digestion
关键词
冷消融
酒精注射
治疗
肝细胞癌
Hepatocellular carcinoma
Cryoablation
Percutaneous ethanol injection
Treatment
