经皮微波消融术治疗小肝癌31例临床分析  

Percutaneous Microwave Ablation for the Treatment of Small Liver Cancer: Analysis of 31 Clinical Cases

作　　者：苏旭[1] 刘育健[1] 李滨[1] 

机构地区：[1]厦门大学附属第一医院肝胆胰血管外科,福建厦门361003

出　　处：《中国卫生标准管理》2016年第15期86-88,共3页China Health Standard Management

摘　　要：目的：探讨超声引导下经皮微波消融术治疗小肝癌的疗效。方法分析我院2012年4月-2015年12月行超声引导下经皮微波消融术治疗小肝癌31例的临床资料，包括血清学检测和影像学检查结果等，分析治疗效果。结果31例患者中，有23例是初发病灶，8例是肝癌术后1年内复发。肿瘤临近血管、胆囊，位于膈下、肝表面及等特殊部位10例，最大径1.0-5.0 cm，行消融术后第1、3个月分别查AFP、超声造影、肝脏增强MRI或增强CT。以后每隔3个月分别复查1次，肿瘤初期完全消融29例，2例术后1个月发现肿瘤仍有活性，经第二次消融肿瘤完全灭活。25例高AFP者术后均下降至正常或接近正常范围。术后6个月发现2例肿瘤局部复发再次消融完全；术后出现3例肝内多发转移癌伴双肺转移，经综合治疗，2例死亡、另1例带瘤生存。围手术期出现脓毒血症1例，未出现肝脓肿、腹腔内出血、消化道出血、肝功能衰竭等严重并发症。术后随诊1-40个月，平均（2.4±2.1）个月，目前总生存率29/31（93.55%）。结论微波消融术治疗小肝癌疗效肯定，安全性高，并发症少。对于合并高血压、糖尿病、肥胖、全身情况欠佳的高危患者、肝癌切除术中定位困难者更具优势。特殊部位肝癌的消融同样安全有效。Objective To explore the short-term outcome of percutaneous microwave ablation（PMA）for the treatment of smal liver cancer.Methods Clinical data（including postoperative serologic and imaging findings）of 28 patients with smal liver cancer who received B-ultrasound-guided PMA therapy in our hospital from June 2012 to December 2015 were analyzed to examine the short-term therapeutic outcome.ResultsA total of 31 nodules（1.0-5.0 cm in diameter）in the 31 patients were treated with PAM. AFP test and CT enhancement scan of the liver were performed at 1,3,6 and 9 months after surgery. Postoperative folow-up of 1-9 months showed that the tumors disappeared completely in 29 patients,and AFP returned to or was near the normal range after surgery in 25 patients whose AFP levels were abnormaly high before surgery. The tumor was found not completely inactivated in one patient one month after surgery. Local tumor recurrence was observed in two patient 6 months after surgery. A new metastatic tumor was detected in one patient with metastatic liver cancer 6 months after surgery. The tumors in the above three patients disappeared after a second cycle of PAM therapy. One patient developed pyemia after surgery,but without hepatic abscess,intra-abdominal hemorrhage,digestive tract hemorrhage or hepatic failure. There was no death in the present series.Postoperative folow-up 1-40 months,average （24±2.1） months,overal survival at present is 29/31（93.55%）. Conclusion The short-term outcome of PAM for the treatment of smal liver cancer is definite. It is safe and minimaly invasive with few complications. In addition,it can be used repeatedly. It is more preferable for high-risk patients with poor general conditions,obese patients,and patients with micro liver cancer whose intraoperative location is difficult.

关 键 词：肝癌 微波 超声引导 

分 类 号：R575[医药卫生—消化系统]