超声引导下激光消融治疗高危部位小肝癌
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摘要
目的通过超声引导下对不同大小、不同部位的小肝癌进行消融治疗,探讨激光消融在高危部位小肝癌消融治疗的临床价值。方法对2012~2014年之间在我院就诊的小肝癌患者共68例73个病灶行激光消融治疗。术后采用超声造影及临床随访对不同大小、不同部位病灶的完全消融率和并发症发生率进行比较。结果≤1 cm组、1~2 cm组、2~3 cm组病灶的完全消融率分别为100%、86.4%、82.7%。3组间差异没有统计学意义(P>0.05)。高危组和非高危组病灶的完全消融率分别为85.7%、92.1%,两组之间的差异没有统计学意义(P>0.05)。并发症发生率在高危组和非高危组分别为9.1%、5.7%,两组之间的差异没有统计学意义(P>0.05)。结论激光消融可较好的运用于高危部位小肝癌的消融治疗。
Objective To investigate the clinical value of ultrasound- guided laser thermal ablation(LTA) in the treatment of small liver cancer at high-risk sites. Methods A total of 73 lesions ablated with LTA in 68 patients with small liver cancer. After the operation, the rates of complete ablation were compared between patients with lesions of different sizes and at different sites using contrast- enhanced ultrasound and the complications were recorded during the follow- up. Results The complete ablation rates for carcinomas ≤1 cm, 1- 2 cm, and 2- 3 cm were 100%, 86.4%, and 82.7%, respectively, showing no significant differences among them(P>0.05). The complete ablation rates of lesions were similar between the high- risk and low- risk groups(85.7% vs 92.1%; P>0.05). The two groups showed no significant difference in the incidence of complications(9.1% vs5.7%; P>0.05). Conclusion Ultrasound-guided LTA can be a good option for treatment of small liver cancers at high-risk sites.
Objective To investigate the clinical value of ultrasound- guided laser thermal ablation(LTA) in the treatment of small liver cancer at high-risk sites. Methods A total of 73 lesions ablated with LTA in 68 patients with small liver cancer. After the operation, the rates of complete ablation were compared between patients with lesions of different sizes and at different sites using contrast- enhanced ultrasound and the complications were recorded during the follow- up. Results The complete ablation rates for carcinomas ≤1 cm, 1- 2 cm, and 2- 3 cm were 100%, 86.4%, and 82.7%, respectively, showing no significant differences among them(P>0.05). The complete ablation rates of lesions were similar between the high- risk and low- risk groups(85.7% vs 92.1%; P>0.05). The two groups showed no significant difference in the incidence of complications(9.1% vs5.7%; P>0.05). Conclusion Ultrasound-guided LTA can be a good option for treatment of small liver cancers at high-risk sites.
引文
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[23]Puls R,Langner S,Rosenberg C,et al.Laser ablation of liver metastases from colorectal cancer with Mr thermometry:5-year survival[J].J Vasc Interv Radiol,2009,20(2):225-34.
[24]Pacella CM,Francica G,Di Lascio FM,et al.Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation:a retrospective analysis[J].J Clin Oncol,2009,27(16):2615-21.
[25]Pompili M,Pacella CM,Francica G,et al.Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation[J].Eur J Radiol,2010,74(3):e6-e11.
[27]Francica G,Petrolati A,Di Stasio E,et al.Effectiveness,safety,and local progression after percutaneous laser ablation for hepatocellular carcinoma nodules up to 4 cm are not affected by tumor location[J].AJR Am J Roentgenol,2012,199(6):1393-401.
[28]Caspani B,Ierardi AM,Motta F,et al.Small nodular hepatocellular carcinoma treated by laser thermal ablation in high risk locations:preliminary results[J].Eur Radiol,2010,20(9):2286-92.
[29]Fiedler VU,Schwarzmaier HJ,Eickmeyer F,et al.Laser-induced interstitial thermotherapy of liver metastases in an interventional0.5 Tesla MRI system:technique and first clinical experiences[J].J Magn Reson Imaging,2001,13(5):729-37.
[2]Ferlay J,Shin HR,Bray F,et al.Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008[J].Int J Cancer,2010,127(12):2893-917.
[3]Chen WQ,Zeng HM,Zheng RS,et al.Cancer incidence and mortality in China,2007[J].Chin J Cancer Res,2012,24(1):1-8.
[4]Llovet JM,Mas X,Aponte JJ,et al.Cost effectiveness of adjuvant therapy for hepatocellular carcinoma during the waiting list for liver transplantation[J].Gut,2002,50(1):123-8.
[5]Bruix J,Sherman M.Management of hepatocellular carcinoma[J].Hepatology,2005,42(5):1208-36.
[6]Llovet JM,Bruix J.Novel advancements in the management of hepatocellular carcinoma in 2008[J].J Hepatol,2008,48(Suppl 1):S20-37.
[7]Livraghi T.Radiofrequency ablation of hepatocellular carcinoma[J].Surg Oncol Clin N Am,2011,20(2):281-99.
[8]Martin RC,Scoggins CR,Mcmasters KM.Safety and efficacy of microwave ablation of hepatic tumors:a prospective review of a 5-year experience[J].Ann Surg Oncol,2010,17(1):171-8.
[9]Lloyd DM,Lau KN,Welsh F,et al.International multicentre prospective study on microwave ablation of liver tumours:preliminary results[J].HPB(Oxford),2011,13(8):579-85.
[10]Bhardwaj N,Strickland AD,Ahmad F,et al.Microwave ablation for unresectable hepatic tumours:clinical results using a novel micro-wave probe and generator[J].Eur J Surg Oncol,2010,36(3):264-8.
[11]Boutros C,Somasundar P,Garrean S,et al.Microwave coagulation therapy for hepatic tumors:review of the literature and critical analysis[J].Surg Oncol,2010,19(1):e22-32.
[12]Inokuchi R,Seki T,Ikeda K,et al.Percutaneous microwave coagulation therapy for hepatocellular carcinoma:increased coagulation diameter using a new electrode and microwave generator[J].Oncol Rep,2010,24(3):621-7.
[13]简志祥,侯宝华,孙建,等.肝动脉化学药物栓塞,B超引导无水酒精瘤内注射和微波射频消融在肝癌肝移植前的应用[J].南方医科大学学报,2006(12):1736-7.
[14]Livraghi T,Solbiati L,Meloni MF,et al.Treatment of focal liver tumors with percutaneous radio-frequency ablation:complications encountered in a multicenter study[J].Radiology,2003,226(2):441-51.
[15]Mulier S,Mulier P,Ni Y,et al.Complications of radiofrequency coagulation of liver tumours[J].Br J Surg,2002,89(10):1206-22.
[16]Rhim H,Yoon KH,Lee JM,et al.Major complications after radiofrequency thermal ablation of hepatic tumors:spectrum of imaging findings[J].Radiographics,2003,23(1):123-34;discussion 134-6.
[17]Komorizono Y,Oketani M,Sako K,et al.Risk factors for local recurrence of small hepatocellular carcinoma tumors after a single session,single application of percutaneous radiofrequency ablation[J].Cancer,2003,97(5):1253-62.
[18]Ebara M,Okabe S,Kita K,et al.Percutaneous ethanol injection for small hepatocellular carcinoma:therapeutic efficacy based on 20-year observation[J].J Hepatol,2005,43(3):458-64.
[19]Koda M,Ueki M,Maeda Y,et al.Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm[J].AJR Am J Roentgenol,2004,183(3):583-8.
[20]Poggi G,Gatti C,Cupella F,et al.Percutaneous US-guided radiofrequency ablation of hepatocellular carcinomas:results in 15patients[J].Anticancer Res,2001,21(1B):739-42.
[21]Horigome H,Nomura T,Nakao H,et al.Percutaneous radiofrequency ablation therapy using a clustered electrode for malignant liver tumors[J].J Clin Gastroenterol,2001,32(5):418-22.
[22]Eickmeyer F,Schwarzmaier HJ,Muller FP,et al.Survival after laser-induced interstitial thermotherapy of colorectal liver metastases-a comparison of first clinical experiences with current therapy results[J].Rofo.2008,180(1):35-41..
[23]Puls R,Langner S,Rosenberg C,et al.Laser ablation of liver metastases from colorectal cancer with Mr thermometry:5-year survival[J].J Vasc Interv Radiol,2009,20(2):225-34.
[24]Pacella CM,Francica G,Di Lascio FM,et al.Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation:a retrospective analysis[J].J Clin Oncol,2009,27(16):2615-21.
[25]Pompili M,Pacella CM,Francica G,et al.Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation[J].Eur J Radiol,2010,74(3):e6-e11.
[27]Francica G,Petrolati A,Di Stasio E,et al.Effectiveness,safety,and local progression after percutaneous laser ablation for hepatocellular carcinoma nodules up to 4 cm are not affected by tumor location[J].AJR Am J Roentgenol,2012,199(6):1393-401.
[28]Caspani B,Ierardi AM,Motta F,et al.Small nodular hepatocellular carcinoma treated by laser thermal ablation in high risk locations:preliminary results[J].Eur Radiol,2010,20(9):2286-92.
[29]Fiedler VU,Schwarzmaier HJ,Eickmeyer F,et al.Laser-induced interstitial thermotherapy of liver metastases in an interventional0.5 Tesla MRI system:technique and first clinical experiences[J].J Magn Reson Imaging,2001,13(5):729-37.