TACE联合CT引导下射频消融治疗特殊部位小肝癌  

Transarterial chemoembolization plus computed tomography-guided percutaneous radiofrequency ablation for small hepatocellular carcinoma in special locations

作　　者：郭永建[1] 黄文薮[1] 周斌[1] 陈俊伟[1] 蔡明岳[1] 钱结胜[1] 黄明声[1] 单鸿[1] 朱康顺[1] 

机构地区：[1]中山大学附属第三医院放射科,广州510630

出　　处：《中华医学杂志》2013年第33期2627-2630,共4页National Medical Journal of China

基　　金：国家自然科学基金（81070349）;广东省科技计划项目（20108031600211）

摘　　要：目的评价肝动脉化疗栓塞（TACE）联合cT引导下射频消融治疗特殊部位小肝癌的安全性和疗效。方法2008年6月至2011年12月在中山大学附属第三医院行TACE联合CT引导下射频消融治疗并随访时间超过6个月的36例小肝癌患者。按肿瘤部位，分为特殊部位组（肿瘤位于肝包膜下、肝门区、大血管或重要脏器旁）20例，非特殊部位组16例。所有患者均在TACE后4—6周行射频消融术，联合治疗后1个月随访CT或MRI增强检查，评价肿瘤完全消融率，此后每1—3个月随访CT或MRI增强检查，评价局部肿瘤进展。比较两组患者并发症发生率、肿瘤完全消融率、局部肿瘤进展率及至肿瘤进展时间（TTP）。结果特殊部位组20例22个病灶，共行TACE24次，消融治疗26次；非特殊部位组16例17个病灶，共行TACEl8次，消融治疗17次。并发症：特殊部位组发生率为46．2％（12／26），其中严重并发症1例，为左心衰，轻微并发症11例，包括血管损伤6例，肝包膜下出血3例，肝动-静脉瘘2例；非特殊部位组发生率为17．6％（3／17）（P=0．101），均为轻微并发症，包括肝包膜下出血1例、肝动．静脉瘘2例。特殊部位组肿瘤完全消融率为68．2％（15／22），而非特殊部位组为100％（17／17）（P=0．012）。特殊部位组6个月、1、2、3年局部肿瘤进展率分别为31．8％、40．9％、45．5％、45．5％，平均TTP为14．4个月；而非特殊部位组6个月、1、2、3年局部肿瘤进展率分别为0、0、0、5．9％，平均TTP为31．5个月，两组比较差异有统计学意义（P＝0．001）。结论TACE联合CT引导下射频消融治疗特殊部位小肝癌安全、可行，但术后局部肿瘤进展率较高，需要密切的影像学随访，及时发现肿瘤残留或复发。Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） plus computed tomography （CT）-guided percutaneous radiofrequency ablation （RFA） for small hepatocellular carcinoma （HCC） in special locations. Methods From June 2008 to December 2011, a total of 36 patients with small HCC （39 lesions） received TACE plus CT-guided percutaneous RFA at our hospital. The follow-up period was over 6 months. They were divided into 2 groups according to the locations of HCC ： special location （located at hepatic subcapsular, portal area, next to large blood vessels or other organs ） and non-special location groups. All patients underwent TACE at one month pre-RFA. Follow-up imaging with enhanced computed tomography （CT） or magnetic resonance imaging （MRI） was performed one month after combined treatment to evaluate the complete ablation rate in two groups. If a complete ablation was achieved, enhanced CT or MRI was performed every 1 - 3 months to evaluate the local tumor progression. The occurrence rate of complications, complete ablation rate,local tumor progression and time to tumor progression （ TTP ） were compared between two groups. Results In the special location group,a total of 24 TACE and 26 ablations were performed in 20 patients with 22 lesions while there were 18 TACE and 17 ablations in 16 patients with 17 lesions in the non-special location group. In the special location group, 12 patients （46.2%） suffered procedure-related complications, including a major complication （n = 1, left ventricular failure） and a minor complication （n = 11 ） of vascular injury （ n = 6 ） , subcapsular hemorrhage （ n = 3 ） and arterial-portal vein fistula （ n = 2 ） ; whereas only 3 patients （ 17.6% ） suffered a minor complication of subcapsular hemorrhage （ n = 1 ） and arterial-portal vein fistula （ n = 2） in the special location group. The occurrence rate of complications was similar between two groups （ P = 0. 101 ）. The c

关 键 词：药物疗法 联合 导管消融术 肝肿瘤 

分 类 号：R735.7[医药卫生—肿瘤]