超声引导单极冷循环射频消融联合TACE治疗肝癌的对比研究  

Comparative Study of Radiofrequency Ablation and Transcatheter Arterial Chemoembolization in Hepatocellular Carcinoma

作　　者：陈岚芬[1] 李丹丹[1] 黄进[1] 李文伦[1] 高振森[1] 

机构地区：[1]潍坊市潍坊医学院附属潍坊市人民医院超声科,山东省潍坊市261041

出　　处：《中国超声医学杂志》2014年第3期238-242,共5页Chinese Journal of Ultrasound in Medicine

基　　金：山东省自然基金项目(No.Y2008C97)

摘　　要：目的探讨超声引导单极冷循环射频消融（radiofrequeneyablation，RFA）联合肝动脉化疗栓塞（transcatheterarterialche－moembolization，TAcE）治疗肝癌的临床价值。方法将273例肝癌患者随机分为3组。A组：TACE联合RFA治疗组90例；B组：单纯TACE组87例；C组：单纯超声引导RFA治疗组96例。A组肝动脉化疗栓塞后1～2周行RFA治疗，其中肝癌伴动静脉瘘栓塞瘘口后再栓塞肿瘤12例，瘘口栓塞不佳改行RFA治疗10例。3组患者治疗后均在1个月后行增强CT（CECT）复查，评估治疗疗效，如发现肿瘤残留行追加治疗。结果治疗后1～3个月行CECT复查评估近期疗效，A、B、C3组肿瘤无强化分别为79．3％（88／111）、52．1％（50／96）、60．0％（63／105），肿瘤部分强化20．7％（23／111）、47．9％（46／96）、40．0％（42／105），其中3．O～5．0cm肿瘤A组与B、C组比较，无强化分别为84．6％、75．0％、81．1％（P＝o．592），差异无显著性意义；5．1～7．0cm肿瘤A组与B、C组比较无强化分别为78．0％、45．7％、55．3％（P＝0．004，P＝0．031），差异有显著性意义；7．1～9．0CITI肿瘤A组与B、C组比较无强化分别为74．2％、34．5％、40．0％（P＝0．002，P＝0．007），差异有显著性意义。6～24个月行CECT肿瘤局部复发为15．1％（47／312），所有患者治疗6个月后肿瘤明显缩小。结论TACE联合RFA对肝癌治疗疗效明显高于单纯TACE或单纯RFA，对〉5．0cm及血供丰富的较大肿瘤应先行TA－CE后再行RFA治疗。Objective To investigate the clinical value of RFA （radiofrequency ablation, RFA） combined with TACE （transcatheter arterial chemoembolization, TACE） for hepatocellular carcinoma. Methods 273 patients were divided into 3 groups randomly. 90 cases were treated with TACE and RFA （group A）, 87 cases with TACE only （group B） and 96 cases with RFA only （group C）. In group A, the RFA was implemented after TACE 1 to 2 weeks, including 12 cases of hepatoeellular carcinoma with arteriovenous fistula that firstly embolized the fistulas, and then embolized tumor, 10 cases were treated with RFA when it＇s not good for the embolization of the fistulas. All patients of 3 groups were examined by enhanced CT one months later to assess the effect, additional treatment was implemen ted when there was residual. Results 1 to 3 months after treatment, CECT was implemented to assess term efficacy. A, B, C three groups with no tumor enhancement was 79.3o/00 （88/111）, 52.1% （50/96）, 60.0% （63/105） respec tively, with partial tumor enhancement was 20.7%（23/111）, 47.9%（46/96）, 40.0%（42/105） respectively. In addi- tion, Group A compared with B and C, tumor size 3.0～5.0 cm, no enhancement were 84.6%, 75.0%, 81.1% （P= 0. 592） respectively, the difference was not statistically significant; Group A compared with B and C, tumor size 5.1～7.0 cm, no enhancement were78.0%, 45.7%, 55.3% （P=0. 004,P=0. 031） respectively, the difference was sta tistically significant; Group A compared with B and C, tumor size 7.1 ～ 9.0 cm, no enhancement were 74.20//00, 34.5%, 40.0% （P=0. 002,P = 0. 007） respectively, the difference was statistically significant. CECT local recur rence was 15.1% （47/312） and the tumors of all patients were significantly reduced after six months following the treatment. Conclusions The combination therapy of TACE with RFA is better than TACE or RFA therapy alone. TACE combined with RFA therapy is good for large tumors（diameter〉5.0 cm）.

关 键 词：肝癌 肝动脉化疗栓塞 射频消融 动静脉瘘 超声引导 

分 类 号：R735.7[医药卫生—肿瘤]