原发性肝癌射频消融术后针道转移再消融治疗效果分析
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摘要
目的研究原发性肝癌射频消融术后针道转移危险因素及消融术治疗效果。方法回顾性分析2017年1月-2018年10月4例原发性肝癌射频消融术后发生针道转移在首都医科大学附属北京佑安医院肝病与肿瘤介入治疗中心行消融术再治疗的患者临床资料,评价危险因素、消融治疗效果及术后并发症发生情况。结果 4例患者肝内肿瘤病灶均临近肝包膜,低分化肝细胞癌2例,中分化肝细胞癌1例,高分化肝细胞癌1例。消融术后发生针道转移时间间隔为3. 6～14. 3个月,针道转移病灶数目均为单发,3例位于前腹壁,1例位于右侧侧腹壁。后行氩氦刀冷冻消融术治疗3例,射频消融术治疗1例。术后2例患者出现发热及暂时性疼痛加重,给予对症治疗后症状缓解,无严重并发症发生。术后1个月复查增强CT显示3例患者转移灶完全消融,随访2～19个月无复发。1例患者局部病灶残余,但疼痛症状较前明显缓解,随访3个月残余灶无明显增大。所有患者术后1个月血清AFP及异常凝血酶原值均明显下降。结论消融治疗尤其是氩氦刀消融术治疗腹壁针道转移灶具有疗效确切、并发症少、耐受性好的优势,对于无法耐受外科手术或不愿意行外科手术的患者是一种较好的治疗选择。
Objective To investigate the risk factors for needle tract implantation after radiofrequency ablation for primary liver cancer and the clinical effect of ablation. Methods A retrospective analysis was performed for the clinical data of 4 patients with needle tract implantation after radiofrequency ablation for primary liver cancer who underwent ablation therapy in Center of Interventional Oncology and Liver Diseases,Beijing You An Hospital,from January 2017 to October 2018. Risk factors,the clinical effect of ablation,and complications were analyzed.Results All four patients had intrahepatic tumor lesions located near the Glisson's capsule,and among these patients,two had poorly differentiated hepatocellular carcinoma( HCC),one had moderately differentiated HCC,and one had well-differentiated HCC. The time from radiofrequency ablation to needle tract implantation ranged from 3. 6 to 14. 3 months,and all four patients had a single lesion of needle tract implantation,which was located at the anterior abdominal wall in three patients and at the right abdominal wall in one patient. Of all patients,three underwent argon-helium cryoablation,and one underwent radiofrequency ablation. Two patients experienced pyrexia and transient aggravation of pain after surgery,and the symptoms were relieved after symptomatic treatment. No serious complication was observed. Contrast-enhanced computed tomography performed at one month after surgery showed complete ablation of metastatic lesion in three patients,with no recurrence after follow-up for 2-19 months. One patient was found to have local residual lesion,with marked relief of pain,and no enlargement of the residual lesion was observed after follow-up for 3 months. All patients had significant reductions in serum alpha-fetoprotein and abnormal prothrombin at one month after surgery. Conclusion Ablation therapy,especially argon-helium cryoablation,has a good clinical effect in the treatment of needle tract implantation at the abdominal wall,with the advantages of few complications and good tolerability. Therefore,it is a good choice for patients who cannot tolerate surgical operation or are unwilling to undergo surgical operation.
Objective To investigate the risk factors for needle tract implantation after radiofrequency ablation for primary liver cancer and the clinical effect of ablation. Methods A retrospective analysis was performed for the clinical data of 4 patients with needle tract implantation after radiofrequency ablation for primary liver cancer who underwent ablation therapy in Center of Interventional Oncology and Liver Diseases,Beijing You An Hospital,from January 2017 to October 2018. Risk factors,the clinical effect of ablation,and complications were analyzed.Results All four patients had intrahepatic tumor lesions located near the Glisson's capsule,and among these patients,two had poorly differentiated hepatocellular carcinoma( HCC),one had moderately differentiated HCC,and one had well-differentiated HCC. The time from radiofrequency ablation to needle tract implantation ranged from 3. 6 to 14. 3 months,and all four patients had a single lesion of needle tract implantation,which was located at the anterior abdominal wall in three patients and at the right abdominal wall in one patient. Of all patients,three underwent argon-helium cryoablation,and one underwent radiofrequency ablation. Two patients experienced pyrexia and transient aggravation of pain after surgery,and the symptoms were relieved after symptomatic treatment. No serious complication was observed. Contrast-enhanced computed tomography performed at one month after surgery showed complete ablation of metastatic lesion in three patients,with no recurrence after follow-up for 2-19 months. One patient was found to have local residual lesion,with marked relief of pain,and no enlargement of the residual lesion was observed after follow-up for 3 months. All patients had significant reductions in serum alpha-fetoprotein and abnormal prothrombin at one month after surgery. Conclusion Ablation therapy,especially argon-helium cryoablation,has a good clinical effect in the treatment of needle tract implantation at the abdominal wall,with the advantages of few complications and good tolerability. Therefore,it is a good choice for patients who cannot tolerate surgical operation or are unwilling to undergo surgical operation.
引文
[1]LI XC,WANG HW,LI CX.Present situation and prospect of comprehensive treatment of hepatocellular carcinoma[J].Chin J Dig Surg,2018,17(5):433-436.(in Chinese)李相成,王宏伟,李长贤.肝癌综合治疗的现状与展望[J].中华消化外科杂志,2018,17(5):433-436.
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[7]CHANG S,KIM SH,LIM HK,et al.Needle tract implantation after sonographically guided percutaneous biopsy of hepatocellular carcinoma:Evaluation doubling time,frequency,and features on CT[J].AJR Am J Roentgenol,2005,185(2):400-405.
[8]KIM SH,LIM HK,LEE WJ,et al.Needle-tract implantation in hepatocellular carcinoma:Frequency and CT findings after biopsy with a 19.5-gauge automated biopsy gun[J].Abdom Imaging,2000,25(3):246-250.
[9]ISHII H,OKADA S,OKUSAKA T,et al.Needle tract implantation of hepatocellular carcinoma after percutaneous ethanol injection[J].Cancer,1998,82(9):1638-1642.
[10]ZHANG DK,JI JS,TU JF,et al.A discussion of reasons and methods of prevention and cure for serious complications of radiofrequency ablations in the treatments of hepatocellular carcinomas[J].Chin J Radiol,2016,50(3):213-216.(in Chinese)张登科,纪建松,涂建飞,等.射频消融治疗肝癌严重并发症原因分析及其防治方法探讨[J].中华放射学杂志,2016,50(3):213-216.
[11]TARANTINO L,FRANCICA G,ESPOSITO F,et al.Seeding from hepatocellular carcinoma after percutaneous ablation:Color Doppler ultrasound findings[J].Abdom Imaging,2006,31(1):69-77.
[12]ARRIVE L,VURGAIT A,MONNIER-CHOLLEY L,et al.Long-term follow-up after neoplastic seeding complicating percutaneous ethanol injection for treatment of hepatocellular carcinoma[J].Eur Radiol,2002,12(1):74-76.
[13]TAKEMURA N,HASEGAWA K,AOKI T,et al.Surgical resection of peritoneal or thoracoabdominal wall implants from hepatocellular carcinoma[J].Br J Surg,2014,101(8):1017-1022.
[14]STIGLIANO R,BURROUGHS AK.Should we biopsy each liver mass suspicious for HCC before liver transplantation?-no,please don’t[J].J Hepatol,2005,43(4):563-568.
[15]WU XY,ZHOU JX,ZHOU T,et al.Diagnosis and treatment of neoplastic needle tract seeding following radiofrequency ablation of primary hepatic carcinoma[J].J Hepatobiliary Surg,2011,19(6):420-422.(in Chinese)吴星宇,周建新,周铁,等.原发性肝癌冷循环射频治疗术后针道种植转移的诊断与治疗[J].肝胆外科杂志,2011,19(6):420-422.
[16]NAKAMURA M,HAYAMI S,UENO M,et al.Detection of needle tract implantation and peritoneal seeding after radiofrequency ablation using intraoperative near-infrared fluorescence system for recurrent hepatocellular carcinoma:A case report[J].Surg Case Rep,2018,4(1):76.
[17]SIDANA A,CHOWDHURY WH,FUCHS EJ,et al.Cryoimmunotherapy in urologic oncology[J].Urology,2010,75(5):1009-1014.
[18]National Health and Family Planning Commission of the People’s Republic of China.Diagnosis,management,and treatment of hepatocellular carcinoma(V2017)[J].J Clin Heptol,2017,33(8):1419-1431.(in Chinese)中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范(2017年版)[J].临床肝胆病杂志,2017,33(8):1419-1431.
[19]MCDEVITT JL,MOULI SK,NEMCEK AA,et al.Percutaneous cryoablation for the treatment of primary and metastatic lung tumors:Identification of risk factors for recurrence and major complications[J].J Vasc Interv Radiol,2016,27(9):1371-1379.
[20]AOUN HD,LITTRUP PJ,JABER M,et al.Percutaneous cryoablation of renal tumors:Is it time for a new paradigm shift?[J].J Vasc Interv Radiol,2017,28(10):1363-1370.
[21]JIANG K,TANG K,GUO X,et al.Laparoscopic cryoablation vs.percutaneous cryoablation for treatment of small renal masses:A systematic review and meta-analysis[J].Oncotarget,2017,8(16):27635-27644.
[22]NIU LZ,HE LH,ZHOU L,et al.Percutaneous cryoablation and125I seed implantation combined with chemotherapy for advanced pancreatic cancer:Report of 67 cases[J].Chin JOncol,2012,34(12):940-944.(in Chinese)牛立志,何丽华,周亮,等.经皮冷消融与125I粒子植入联合化疗治67例晚期胰腺癌的疗效和安全性[J].中华肿瘤杂志,2012,34(12):940-944.
[2]CHEN Y,ZHOU J,FAN J,et al.Clinical effect and prognostic factors analysis of intraoperative radiofrequency ablation in treatment of hepatocellular carcinoma with severe cirrhosis[J].Chin J Dig Surg,2017,16(2):159-163.(in Chinese)陈漪,周俭,樊嘉,等.术中射频消融治疗合并重度肝硬化肝细胞癌的临床疗效及预后因素分析[J].中华消化外科杂志,2017,16(2):159-163.
[3]LLOVET JM,VLIANA R,BRU C,et al.Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocelhlar carcinoma[J].Hepatology,2001,33(5):1124-1129.
[4]MULIER S,MULIER P,NI Y,et al.Complications of radiofrequency coagulation of liver tumours[J].Br J Surg,2002,89(10):1206-1222.
[5]RHIM H,YOON KH,LEE JM,et al.Major complications after Radio-frequency thermal ablation of hepatic tumors:Spectrum of imaging findings[J].Radio Graphics,2003,23(1):123-136.
[6]CHANG S,KIM SH,LIM HK,et al.Needle tract implantation after percutaneous interventional procedures in hepatocellular carcinomas:Lessons learned from a 10-year experience[J].Korean J Radiol,2008,9(3):268-274.
[7]CHANG S,KIM SH,LIM HK,et al.Needle tract implantation after sonographically guided percutaneous biopsy of hepatocellular carcinoma:Evaluation doubling time,frequency,and features on CT[J].AJR Am J Roentgenol,2005,185(2):400-405.
[8]KIM SH,LIM HK,LEE WJ,et al.Needle-tract implantation in hepatocellular carcinoma:Frequency and CT findings after biopsy with a 19.5-gauge automated biopsy gun[J].Abdom Imaging,2000,25(3):246-250.
[9]ISHII H,OKADA S,OKUSAKA T,et al.Needle tract implantation of hepatocellular carcinoma after percutaneous ethanol injection[J].Cancer,1998,82(9):1638-1642.
[10]ZHANG DK,JI JS,TU JF,et al.A discussion of reasons and methods of prevention and cure for serious complications of radiofrequency ablations in the treatments of hepatocellular carcinomas[J].Chin J Radiol,2016,50(3):213-216.(in Chinese)张登科,纪建松,涂建飞,等.射频消融治疗肝癌严重并发症原因分析及其防治方法探讨[J].中华放射学杂志,2016,50(3):213-216.
[11]TARANTINO L,FRANCICA G,ESPOSITO F,et al.Seeding from hepatocellular carcinoma after percutaneous ablation:Color Doppler ultrasound findings[J].Abdom Imaging,2006,31(1):69-77.
[12]ARRIVE L,VURGAIT A,MONNIER-CHOLLEY L,et al.Long-term follow-up after neoplastic seeding complicating percutaneous ethanol injection for treatment of hepatocellular carcinoma[J].Eur Radiol,2002,12(1):74-76.
[13]TAKEMURA N,HASEGAWA K,AOKI T,et al.Surgical resection of peritoneal or thoracoabdominal wall implants from hepatocellular carcinoma[J].Br J Surg,2014,101(8):1017-1022.
[14]STIGLIANO R,BURROUGHS AK.Should we biopsy each liver mass suspicious for HCC before liver transplantation?-no,please don’t[J].J Hepatol,2005,43(4):563-568.
[15]WU XY,ZHOU JX,ZHOU T,et al.Diagnosis and treatment of neoplastic needle tract seeding following radiofrequency ablation of primary hepatic carcinoma[J].J Hepatobiliary Surg,2011,19(6):420-422.(in Chinese)吴星宇,周建新,周铁,等.原发性肝癌冷循环射频治疗术后针道种植转移的诊断与治疗[J].肝胆外科杂志,2011,19(6):420-422.
[16]NAKAMURA M,HAYAMI S,UENO M,et al.Detection of needle tract implantation and peritoneal seeding after radiofrequency ablation using intraoperative near-infrared fluorescence system for recurrent hepatocellular carcinoma:A case report[J].Surg Case Rep,2018,4(1):76.
[17]SIDANA A,CHOWDHURY WH,FUCHS EJ,et al.Cryoimmunotherapy in urologic oncology[J].Urology,2010,75(5):1009-1014.
[18]National Health and Family Planning Commission of the People’s Republic of China.Diagnosis,management,and treatment of hepatocellular carcinoma(V2017)[J].J Clin Heptol,2017,33(8):1419-1431.(in Chinese)中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范(2017年版)[J].临床肝胆病杂志,2017,33(8):1419-1431.
[19]MCDEVITT JL,MOULI SK,NEMCEK AA,et al.Percutaneous cryoablation for the treatment of primary and metastatic lung tumors:Identification of risk factors for recurrence and major complications[J].J Vasc Interv Radiol,2016,27(9):1371-1379.
[20]AOUN HD,LITTRUP PJ,JABER M,et al.Percutaneous cryoablation of renal tumors:Is it time for a new paradigm shift?[J].J Vasc Interv Radiol,2017,28(10):1363-1370.
[21]JIANG K,TANG K,GUO X,et al.Laparoscopic cryoablation vs.percutaneous cryoablation for treatment of small renal masses:A systematic review and meta-analysis[J].Oncotarget,2017,8(16):27635-27644.
[22]NIU LZ,HE LH,ZHOU L,et al.Percutaneous cryoablation and125I seed implantation combined with chemotherapy for advanced pancreatic cancer:Report of 67 cases[J].Chin JOncol,2012,34(12):940-944.(in Chinese)牛立志,何丽华,周亮,等.经皮冷消融与125I粒子植入联合化疗治67例晚期胰腺癌的疗效和安全性[J].中华肿瘤杂志,2012,34(12):940-944.