冷循环射频消融治疗肝癌的疗效分析  

Therapeutic effects of cool-tip radiofrequency ablation in treatment of hepatocellular carcinoma

作　　者：罗葆明[1] 杨海云[1] 文艳玲[1] 智慧[1] 马健鸿[1] 潘景升[1] 王军华 

机构地区：[1]中山大学附属第二医院超声科,广州510120 [2]佛山市第一医院超声科

出　　处：《中华超声影像学杂志》2005年第3期208-211,共4页Chinese Journal of Ultrasonography

基　　金：广东省自然科学基金(31710);广东省卫生厅医学科研项目(A2003203)资助

摘　　要：目的　探讨冷循环射频消融治疗肝癌的方法、适应症及其疗效。方法　应用冷循环射频消融治疗肝细胞癌患者 168例共 217个病灶,其中第 1组 113例共 147个病灶,肿瘤直径 <3cm;第 2组 35例共 49个病灶,肿瘤直径 3~5cm;第 3组 20例共 21个病灶,肿瘤直径>5cm。观察治疗前后患者丙氨酸转氨酶、甲胎蛋白(AFP)、CD4+、CD8+、CD4+ /CD8+值和可溶性白介素 2受体 (sIL 2R)、二维及彩色多普勒血流显像、超声造影、增强CT/MRI的改变。记录患者治疗后 1、2、3年生存率。结果　第 1组病灶完全坏死率为 89. 1% (131 /147),术后 1个月AFP明显下降,术后 1、2、3年生存率分别为 96. 6% (84 /87)、71. 2% (42 /59)和 63. 0% (17 /27)。第2组病灶完全坏死率为 53. 1% ( 26 /49 ),术后 1月AFP下降,术后 1、2、3年生存率分别为 82. 1% ( 23 /28 )、63. 2% (12 /19)和 44. 4% (4 /9)。第 3组仅 4个病灶 (占 19. 0% )为完全坏死,术后 1个月仅 1例AFP下降至25μg/L以下, 1年生存率 62. 5% (10 /16), 2年生存率 44. 4% (4 /9),存活 3年以上仅 1例(1 /4)。20例肝细胞癌患者与健康对照者相比CD4+、CD4+ /CD8+显著降低,sIL 2R显著增高;治疗后CD4+值升高、CD4+ /CD8+值升高,sIL 2R显著降低。结论　射频消融治疗小肝癌可获显著疗效。Objective To evaluate the therapeutic effects of the cooled-tip radiofrequency ablation(CRFA) in the treatment of hepatocellular carcinoma(HCC).Methods One hundred and sixty-eight patients of HCC with 217 lesions were treated by CRFA.Among them one hundred and thirteen patients with 147 nodules(diameter <3 cm) were in the first group,thirty-five patients with 49 nodules(diameter 3-5 cm) in the second group,twenty patients with 21 nodules(diameter >5 cm) in the third group.ATL,serum AFP,CD4^+,CD8^+,CD4^+/CD8^+,sIL-2R,B-mode ultrasonography,color Doppler flow imaging(CDFI), contrast ultrasound,contrast enhanced CT/MRI were examined before and after CRFA.Survival rate of 1-year,2-year,3-year was recorded.Results (89.1%) of lesions were completely necrotic in the first group.Serum AFP value was significantly decreased 1 month after CRFA.Survival rate of 1-year,2-year,3-year was (96.6%),(71.2%),(63.0%),respectively.(53.1%) of lesions were completely necrotic in the second group.Serum AFP value was decreased 1 month after CRFA.Survival rate of 1-year,2-year,3-year was (82.1%),(63.2%),(44.4%),respectively.In the third group,only 4 lesions were completely necrotic.AFP value was less than 25 μg/L 1 month after CRFA only in one patient.Survival rate of 1-year,2-year,3-year was (62.5%)(10/16),(44.4%)(4/9),(25.0%)(1/4),respectively.Compared with normal controls,CD4^+ and CD4^+/CD8^+ value of 20 patients with HCC were significantly decreased and sIL-2R value significantly increased before CRFA, and CD4^+ and CD4^+/CD8^+ value of 20 patients with HCC were significantly increased and sIL-2R value significantly decreased after CRFA.Conclusions CRFA can improve anti-tumor immune of the patients.Definite therapeutic response of RFA is obvious in the treatment of small HCCs.The therapy including CRFA,TACE and percutaneous ethanol injection should be used in large HCCs.

关 键 词：病灶 患者 射频消融治疗 生存率 术后 肝癌 AFP CD4^+ 坏死 存活 

分 类 号：R735.7[医药卫生—肿瘤]