微波消融治疗肝转移癌的临床疗效  

Clinical efficacy of microwave ablation for the treatment of hepatic metastases

作　　者：秦辉[1] 葛勇胜[1,2] 许戈良[1,2] 马金良[1,2] 荚卫东[1,2] 余继海[1,2] 张传海[1,2] 刘文斌[1,2] 

机构地区：[1]安徽医科大学附属省立医院普外科,合肥230001 [2]安徽医科大学附属省立医院肝胆胰外科安徽省重点实验室,合肥230001

出　　处：《安徽医科大学学报》2016年第6期841-845,共5页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81272398);安徽省自然科学基金(编号:1308085MH147)

摘　　要：目的探讨微波消融（MWA）治疗肝转移癌的临床疗效和影响生存率的相关因素。方法回顾性分析47例（73个结节）行MWA治疗的肝转移癌患者的临床资料。其中结肠癌肝转移16例、直肠癌肝转移9例、胃癌肝转移14例、其他部位肿瘤肝转移8例。肿瘤1.5-13.0（6.2±3.5）cm。观察完全消融（CA）率、局部复发率、再发率及生存率。采用电话或门诊随访。生存率的单因素分析采用Kaplan-Meier方法,显著性检验采用Log-rank test方法;多因素分析采用Cox比例风险回归模型方法;生存曲线采用Kaplan-Meier方法。结果判断局部疗效的CA率为89.0%,其中,结节≤3.0 cm、3.0 cm〈≤5.0 cm及〉5.0 cm组的CA率分别100.0%、92.0%和76.9%,〉5.0 cm组CA率明显低于其他两组（P〈0.05）。结节局部复发率为15.4%,其中结节≤3.0 cm、3 cm〈≤5 cm及〉5.0 cm组的结节复发率分别4.5%、13.0%和30.0%。肝内新发部位出现新转移灶的再发率为42.5%。随访时间为1-36（25.1±8.2）个月。1、2、3年的累积生存率分别为74.5%、48.9%及27.7%,中位生存期20.0个月。单因素分析结果表明,肿瘤的数目、肿瘤直径、肿瘤分化程度和肿瘤的原发部位对生存率的影响差异有统计学意义;而患者的年龄、性别和有无肝外转移对生存率的影响差异无统计学意义。Cox多因素分析结果表明,肿瘤的数目和原发肿瘤部位对生存率的影响差异有统计学意义。结论 MWA治疗对单个结节的结直肠肝转移癌的临床疗效满意,对复发或再发病例可以反复治疗,能够延长患者生存期,改善生存质量。Objective To explore therapeutic results of local microwave ablation（ MWA） for hepatic metastasis and the factors influencing the survival after microwave therapy. Methods The clinical data of 47 patients（ 73 liver metastatic lesions） with metastasis hepatic carcinoma who received MWA were retrospectively analyzed. Of the 47 patients,16 were with liver metastasis from colonic cancer,9 with liver metastasis from rectal cancer,14 with liver metastasis from gastric cancer,and 8 with liver metastasis from other cancers. The diameter of the metastasis lesion ranged from 1. 5 - 13. 0（ 6. 2 ± 3. 5） cm. Complete ablation rate,local and distant recurrence rate and survival rate were evaluated respectively. Patients were followed up via phone call and out-patient examination. Survival analysis was evaluated by the Kaplan-Meier method,and the differences between survival rates were ascertained using the Log-rank test. Significant variables from the univariate analysis were included in the multivariate analysis,which was performed using the Cox proportional hazards model. Results The complete ablation（ CA） rate which was used to evaluate the local therapeutic effects was 89. 0%,with 100. 0%,92. 0% and 76. 9% in a diameter of lesions≤3. 0 cm,3. 0 - 5. 0 cm and 5. 0 cm respectively. The CA rate was lower in the group of a diameter of lesions 5. 0cm as compared with two other groups（ P〈0. 05）. The local recurrence rate was 15. 4%,with 4. 5%,13. 0% and30. 0% in a diameter of lesions≤3. 0 cm,3. 0 - 5. 0 cm and 5. 0 cm respectively. The new intrahepatic distant recurrence rate was 42. 5%. The follow-up time after MWA was 1 - 36（ 25. 1 ± 8. 2） months. During the follow-up period,1 year,2 year and 3 year cumulative survival rates were 74. 5%,48. 9% and 27. 7% respectively,with a median survival time of 20. 0 months. Univariate analysis of prognostic factors indicated that tumor size,number of metastases,tumor cell differentiation and primary site of tumors had significant prognostic influence on overa

关 键 词：肝转移癌 微波消融 预后 

分 类 号：R730.7[医药卫生—肿瘤]