阻断肿瘤血供后微波凝固治疗肝癌的临床研究(附120例临床分析)  

Treatment of liver cancer with microwave coagulation after interruption of cancerous blood supply:a clinical analysis of 120 cases

作　　者：肖震宇[1] 陈孝平[1] 黄志勇[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科中心,武汉市430030

出　　处：《中华肝胆外科杂志》2005年第12期806-808,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：2001-2003年卫生部临床学科重点项目资助(WKZ-2000-1-15)

摘　　要：目的探讨阻断肿瘤血供后微波凝固治疗肝癌的疗效.方法 120例经组织学证实的肝癌病人,104例为原发性肝癌,16例为转移癌,共289个肿瘤结节,分为两个治疗组:(1)经导管动脉化疗栓塞(TACE)后1～2 d 内行超声引导下微波热凝固治疗(PMCT)70例;(2)手术中暂时阻断肝门血流后行肝癌微波热凝固治疗(MCT)50例.结果治疗中B超监测微波凝固范围显示:单电极60 W、180 s时,TACE+PMCT组和术中阻断肝门血流+MCT组肿瘤凝固体积分别为20～92 cm3和18～85 cm3,明显超过单纯的微波热疗时8～15 cm3的凝固体积;治疗后随访6～36个月,98例病人AFP转为正常水平,占81.7%;59例病人再活检,其中肿瘤完全坏死者为48例,占81.4%;TACE+PMCT组有66例肿瘤不同程度缩小(94.2%);术中阻断肝门血流+MCT组有43例肿瘤不同程度缩小(86%);两组半年,1,2年生存率分别为96.5%、89.3%、79.9%和95.5%、85.5%、63.3%.结论无论是TACE联合PMCT,还是术中阻断肝门血流联合MCT 治疗肝癌,两种方法均可显著地增强微波热疗的局部作用,扩大肿瘤凝固坏死范围,从而更加有效地杀灭肝癌细胞.Objective To evaluate the efficacy of microwave coagulation therapy （MCT） for liver cancer after interruption of cancerous blood supply. Methods A total of 289 nodules of liver cancer in 120 patients were diagnosed by liver biopsy. Of the 120 patients, 104 were with HCC and 16 with metastatic liver tumor. The patients were divided into 2 groups： 70 underwent TACE followed hy ul trasound-guided PMCT within 1-2 d （group A） and 50 received MCT after temporary interruption of hepatic portal blood flow （group B）. During the treatments, ultrasonography was conducted to moni- tor the range of microwave coagulation. Results Using single electrode at 60W for 100 seconds, the coagulated range in group A was 20-92cm^3 and that in group B was 18-85cm^3. The coagulated range in both groups was wider than that by sole MCT （8 15cma）. The follow-up was carried on for 6 36 months. AFP level was normalized in 98 patients （81.6%）. The post-treated biopsy in 58 patients showed complete destruction of the tumor in 48 （81. 4%）. In the group of TACE4-PMCT, 66 lesions （94.2%） significantly shrank. In the group of operative interruption ＋ MCT, 43 lesions （86%） markedly shrank. The 6 month, 1- and 2 year survival rates in the 2 groups were 96.5%, 89.3%, 79.9% and 95.5%, 85.5%, 63.3%, respectively. Conclusions Both method of TACE4-PMCT and operative interruption 4- MCT can enhance the local effect of microwave coagulation and markedly en large tissue coagulation region to efficiently kill the hepatocareinoma cells.

关 键 词：癌 肝细胞 微波凝固治疗 化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤] R739.41[医药卫生—临床医学]