CT引导下经皮微波消融治疗膈顶部复发性小肝癌15例疗效观察
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摘要
目的:回顾性分析经肝脏CT引导下经皮微波消融(CT-MWA)治疗膈顶区域复发性小肝癌的临床疗效及安全性。方法:对2009年8月至2015年2月共15例位于膈顶部位复发性小肝癌患者的小病灶(<3cm)进行CT引导下经皮微波消融术治疗的临床资料进行回顾性分析。分析总结微波消融治疗膈顶复发性小肝癌的1、3年生存率、完全消融率、局部进展率、术中及术后并发症、不良反应。结果:本研究15个小病灶进行CT-MWA治疗成功率和完全消融率分别为93.33%(14/15)和86.67%(13/15)。术中疼痛发生率为46.67%(7/15)。术后常见不良反应为肝区疼痛(33.33%)、胃肠道反应(46.67%)、发热(13.33%)、肝功能异常(13.33%),无肝功能衰竭、胆瘘、感染、出血等严重并发症,无围手术期死亡病例。15例患者平均存活时间为42个月。术后3个月、6个月、1年及1年以上的肿瘤局部进展率分别为6.67%(1/15)、6.67%(1/15)、13.33%(2/15)、13.33%(2/15)。1、2、3年生存率分别为86.67%(13/15)、66.67%(10/15)、46.67%(7/15)。结论:经皮CT-MWA治疗膈顶区域复发性小肝癌是一种安全有效的微创治疗方法,值得扩大样本量进一步研究。
Objective: To retrospectively analyze the clinical efficacy and safety of CT-guided percutaneous microwave ablation( CT-MWA) in the treatment of recurrent small hepatocellular carcinoma( HCC). Methods: A total of 15 patients with recurrent small HCC which against the diaphragmatic dome underwent CT-MWA of clinical data from August 2009 to February 2015 were retrospectively analyzed. To summarize the 1,3-year survival rate,complete ablation rate,local rate of progress,intraoperative and postoperative complications and adverse reactions in the treatment of recurrent small HCC against the diaphragmatic dome. Results: The success rate and complete ablation rate were 93. 33%( 14/15) and 86. 67%( 13/15) respectively. The incidence of intraoperative pain was 46. 67%( 7/15). Postoperative adverse reactions included gastrointestinal reactions( 46. 67%),liver pain( 33. 33%),fever( 13. 33%),abnormal liver function( 13. 33%). No liver failure,biliary fistula,infection,bleeding and other serious complication,no perioperative death cases. The average survival time was 42 months for 15 patients. The local progression rates of 3 months,6 months,1 year and more than 1 year were 6. 67%( 1/15),6. 67%( 1/15),13. 33%( 2/15) and 13. 33%( 2/15),respectively. The survival rates of 1 year,2 years and 3 years were 86. 67%( 13/15),66. 67%( 10/15) and 46. 67%( 7/15),respectively. Conclusion: For recurrent small HCC against the diaphragmatic dome,percutaneous CT-MWA is a safe and effective minimally invasive treatment and it is worth to further study with more samples.
Objective: To retrospectively analyze the clinical efficacy and safety of CT-guided percutaneous microwave ablation( CT-MWA) in the treatment of recurrent small hepatocellular carcinoma( HCC). Methods: A total of 15 patients with recurrent small HCC which against the diaphragmatic dome underwent CT-MWA of clinical data from August 2009 to February 2015 were retrospectively analyzed. To summarize the 1,3-year survival rate,complete ablation rate,local rate of progress,intraoperative and postoperative complications and adverse reactions in the treatment of recurrent small HCC against the diaphragmatic dome. Results: The success rate and complete ablation rate were 93. 33%( 14/15) and 86. 67%( 13/15) respectively. The incidence of intraoperative pain was 46. 67%( 7/15). Postoperative adverse reactions included gastrointestinal reactions( 46. 67%),liver pain( 33. 33%),fever( 13. 33%),abnormal liver function( 13. 33%). No liver failure,biliary fistula,infection,bleeding and other serious complication,no perioperative death cases. The average survival time was 42 months for 15 patients. The local progression rates of 3 months,6 months,1 year and more than 1 year were 6. 67%( 1/15),6. 67%( 1/15),13. 33%( 2/15) and 13. 33%( 2/15),respectively. The survival rates of 1 year,2 years and 3 years were 86. 67%( 13/15),66. 67%( 10/15) and 46. 67%( 7/15),respectively. Conclusion: For recurrent small HCC against the diaphragmatic dome,percutaneous CT-MWA is a safe and effective minimally invasive treatment and it is worth to further study with more samples.
引文
[1]Xu Jifan,Luo Shiqiao,Du Bo.Early diagnosis and treatment of recurrment liver cancer[J].Modern Oncology,2017,25(14):2346-2350.[许继凡,罗诗樵,杜波.复发性肝癌的早期诊断及治疗策略[J].现代肿瘤医学,2017,25(14):2346-2350.]
[2]Fukuhara T,Aikata H,Hyogo H,et al.Efficacy of radiofrequency ablation for initial recurrent hepatocellular carcinoma after curative treatment:Comparison with primary cases[J].Eur J Radiol,2015,84(8):1540-1545.
[3]Dodson RM,He J,Pawlik TM.Resection and transplantation for hepatocellular carcinoma:Factors influencing surgical options[J].Future Oncol,2014,10(4):587-607.
[4]Zhang TT,Li KY,Luo HC,et al.Long-term outcomes of percutaneous microwave ablation versus repeat hepatectomy for treatment of late recurrent small hepatocellular carcinoma:A retrospective study[J].National Medical Journal of China,2014,94(33):2570-2572.[张婷婷,李开艳,罗鸿昌,等.经皮微波消融和二次手术治疗晚期复发型小肝癌的长期疗效观察[J].中华医学杂志,2014,94(33):2570-2572.]
[5]Huang J,Yan L,Wu H,et al.Is radiofrequency ablation applicable for recurrent hepatocellular carcinoma after liver transplantation[J]?J Surg Res,2016,200(1):122-130.
[6]Tang T,Gu SZ,Li GW,et al.Ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome[J].Journal of Central South University(Medical Science),2017,42(2):184-188.[唐田,古善智,李国文,等.超声引导联合人工胸水微波消融膈顶部肝肿瘤[J].中南大学学报(医学版),2017,42(2):184-188.]
[7]Liu LN,Xu HX,Lu MD,et al.Percutaneous ultrasound-guided thermal ablation for liver tumor with artificial pleural effusion or ascites[J].Chin J Cancer,2010,29(9):830-835.
[8]Li M,Yu XL,Liang P,et al.Percutaneous microwave ablation for liver cancer adjacent to the diaphragm[J].Int J Hyperthermia,2012,28(3):218-226.
[9]Zytoon AA,Ishii H,Murakami K,et al.Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma.A registry report of the impact of risk factors on outcome[J].Jpn J Clin Oncol,2007,37(9):658-672.
[10]Head HW,Dodd GD,Dalrymple NC,et al.Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm:Frequency of diaphragmatic injury[J].Radiology,2007,243(3):877-884.
[11]Kurokohchi K,Hirai S,Ohgi T,et al.Thoracoscopic ethanol injection and radiofrequency ablation for the treatment of hepatocellular carcinoma located immediately under the diaphragm[J].Int J Oncol,2006,29(2):375-380.
[12]Zhang LH,Zhang CY,Dai XZ,et al.Efficacy of microwave ablation versus remedial hepatectomy for postoperative recurrent small hepatocellular carcinoma[J].Chinese Journal of General Surgery,2015,30(8):631-634.[张立洪,张传永,戴新征,等.术后复发性小肝癌微波消融与再次手术切除的疗效比较[J].中华普通外科杂志,2015,30(8):631-634.]
[2]Fukuhara T,Aikata H,Hyogo H,et al.Efficacy of radiofrequency ablation for initial recurrent hepatocellular carcinoma after curative treatment:Comparison with primary cases[J].Eur J Radiol,2015,84(8):1540-1545.
[3]Dodson RM,He J,Pawlik TM.Resection and transplantation for hepatocellular carcinoma:Factors influencing surgical options[J].Future Oncol,2014,10(4):587-607.
[4]Zhang TT,Li KY,Luo HC,et al.Long-term outcomes of percutaneous microwave ablation versus repeat hepatectomy for treatment of late recurrent small hepatocellular carcinoma:A retrospective study[J].National Medical Journal of China,2014,94(33):2570-2572.[张婷婷,李开艳,罗鸿昌,等.经皮微波消融和二次手术治疗晚期复发型小肝癌的长期疗效观察[J].中华医学杂志,2014,94(33):2570-2572.]
[5]Huang J,Yan L,Wu H,et al.Is radiofrequency ablation applicable for recurrent hepatocellular carcinoma after liver transplantation[J]?J Surg Res,2016,200(1):122-130.
[6]Tang T,Gu SZ,Li GW,et al.Ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome[J].Journal of Central South University(Medical Science),2017,42(2):184-188.[唐田,古善智,李国文,等.超声引导联合人工胸水微波消融膈顶部肝肿瘤[J].中南大学学报(医学版),2017,42(2):184-188.]
[7]Liu LN,Xu HX,Lu MD,et al.Percutaneous ultrasound-guided thermal ablation for liver tumor with artificial pleural effusion or ascites[J].Chin J Cancer,2010,29(9):830-835.
[8]Li M,Yu XL,Liang P,et al.Percutaneous microwave ablation for liver cancer adjacent to the diaphragm[J].Int J Hyperthermia,2012,28(3):218-226.
[9]Zytoon AA,Ishii H,Murakami K,et al.Recurrence-free survival after radiofrequency ablation of hepatocellular carcinoma.A registry report of the impact of risk factors on outcome[J].Jpn J Clin Oncol,2007,37(9):658-672.
[10]Head HW,Dodd GD,Dalrymple NC,et al.Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm:Frequency of diaphragmatic injury[J].Radiology,2007,243(3):877-884.
[11]Kurokohchi K,Hirai S,Ohgi T,et al.Thoracoscopic ethanol injection and radiofrequency ablation for the treatment of hepatocellular carcinoma located immediately under the diaphragm[J].Int J Oncol,2006,29(2):375-380.
[12]Zhang LH,Zhang CY,Dai XZ,et al.Efficacy of microwave ablation versus remedial hepatectomy for postoperative recurrent small hepatocellular carcinoma[J].Chinese Journal of General Surgery,2015,30(8):631-634.[张立洪,张传永,戴新征,等.术后复发性小肝癌微波消融与再次手术切除的疗效比较[J].中华普通外科杂志,2015,30(8):631-634.]