105例射频消融治疗肝脏肿瘤的不同介导方式的比较  

A comparative study of radiofrequency ablation and ethanol injection under different guidance means for 105 patients with primary and metastatic hepatic cancer

作　　者：刘树佳[1] 陈敏山[2] 熊莲花[1] 李锦清[2] 陈祥洪[1] 袁湘瑜[1] 

机构地区：[1]广东省东莞市人民医院肿瘤外科,广东东莞523018 [2]中山大学肿瘤防治中心肝胆外科

出　　处：《中国医师杂志》2005年第12期1611-1613,共3页Journal of Chinese Physician

基　　金：广东省东莞市科技局社会发展攻关基金资助(B2003-5)

摘　　要：目的探讨和比较不同方式介导的射频联合瘤内无水酒精注射治疗肝癌的有效性与安全性。方法总结分析射频联合瘤内无水酒精注射治疗原发性肝癌及转移性肝癌病人105例的临床资料,其中经皮超声介导56例、经皮CT介导12例、腹腔镜介导9例、开腹术中26例、经皮超声+腹腔镜2例。结果手术时间最短为经皮超声介导为(0.8±0.3)h,最长为开腹术中为(3.6±2.5)h(P<0.01),恢复时间最短为经皮CT及超声介导为(2.9±2.2)d和(3.0±0.8)d,最长为开腹术中为(10.3±2.3)d(P<0.01);原位复发率最高是经皮CT介导达16.6%,并发症发生率经皮CT介导为最高达8.3%,但无统计学意义;3年生存率各种介导方式无明显差异。常见的并发症为发热、疼痛、肝功能受损、出血,极少发生严重并发症或与操作相关的死亡。结论各种介导方法各有优点,应根据实际情况选择相应的介导方法,各种方法中以经皮超声介导最为简单可靠。Objective To investigate the effect and safety of the application of radiofrequency ablation （RFA） and ethanol injection under the different guidance means for 105 patients with primary and metastatic hepatic cancer. Methods A retrospective study was accomplished on the radiofrequeney ablation and ethanol injection for 105 patients with primary and metastatic hepatic cancer under the guidance of ultrasound （56 cases） , CT （12 cases） , laparoscope （9 cases）, open surgery （26 cases） and ultrasound associated with laparoseopic （2 cases）. Results The operations of RFA with the shortest time were guided by ultrasound （0. 8 ±0. 3） h, while the longest operations were guided by open surgery（3.6± 2. 5） h （ P 〈 0. 01 ）. The operations with the shortest recovery time in RFA were guided by CT（ 2.9 ± 2. 2 days ） or ultrasound （ 3.0 ± 0. 80 days）, while those with the longest recovery time were guided by open surgery （ 1 0. 3 ± 2. 3 ） （ P 〈 0.01 ）. The operations with the maximum rate of recurrence in situ and complications were all guided by CT（ 16. 6%, 8.3% ）. There was not signifi- cant difference in the survival rate of 3 years between the different guidance means. The frequent complications included fever, local pain, liver impairment and hemorrhage. Conclusion Of 5 guidance means, each has its own merit and the choice is determined by the practice. Among them, radiofrequency ablation and ethanol injection under the guidance of ultrasound is the most simple and safe.

关 键 词：无水酒精 射频消融 肝脏肿瘤 介导方式 超声介导 并发症 

分 类 号：R735.7[医药卫生—肿瘤] R730.5[医药卫生—临床医学]