CT引导下经皮冷冻消融治疗高危部位肝恶性肿瘤患者的疗效分析  

The efficacy and safety of computed tomography-guided percutaneous cryoablation for malignant liver tumors at high-risk sites

作　　者：张炜浩 赵晓辉 王艳 于海鹏 邢文阁 司同国 Zhang Weihao;Zhao Xiaohui;Wang Yan;Yu Haipeng;Xing Wenge;Si Tongguo(Department of Interventional Therapy,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin′s Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China;Department of Interventional Therapy,Tianjin Cancer Hospital Airport Hospital,Tianjin 300308,China)

机构地区：[1]天津医科大学肿瘤医院介入治疗科、天津市肿瘤防治重点实验室、天津市恶性肿瘤临床医学研究中心、国家恶性肿瘤临床医学研究中心,天津300060 [2]天津市肿瘤医院空港医院微创介入治疗科,天津300308

出　　处：《中华内科杂志》2024年第8期762-768,共7页Chinese Journal of Internal Medicine

基　　金：天津市教委科研计划项目(2023KJ090)。

摘　　要：目的分析CT引导下经皮冷冻消融治疗高危部位肝恶性肿瘤的疗效和安全性。方法回顾性收集2018年1月到2021年12月在天津医科大学肿瘤医院接受经皮冷冻消融治疗的肝恶性肿瘤患者资料,通过肿瘤最大径进行1∶1匹配同期收治的46例非高危部位肝恶性肿瘤患者。评估技术成功率及12个月和24个月的完全消融率及并发症情况。统计分析高危部位组和非高危部位组之间患者消融效果差异。采用单因素分析、多因素logistic回归分析独立危险因素。结果两组术中技术成功率均为100%,未发生严重并发症。高危部位组和非高危部位组12、24个月的完全消融率分别为82.6%(38/46)比84.8%(39/46)、71.7%(33/46)比73.9%(34/46),两组间差异无统计学意义(均P>0.05)。多因素分析结果显示,肿瘤边缘至高危部位距离≤5 mm、术前是否接受TACE治疗是影响冷冻消融效果的独立危险因素。结论CT引导下经皮冷冻消融治疗高危部位的肝恶性肿瘤安全有效,但需要合理的术前规划和谨慎术中操作。ObjectiveTo assess the efficacy and safety of computed tomography(CT)-guided percutaneous cryoablation in treating malignant liver tumors located explicitly at high-risk sites.MethodsData were collected retrospectively from patients with malignant liver tumors undergoing percutaneous cryoablation at Tianjin Medical University Cancer Hospital between January 2018 and December 2021.In all,46 patients with malignant liver tumors at non-high-risk sites were matched 1∶1 according to the maximum tumor diameter.Technical success rate,complete ablation rate,and complications at 12 and 24 months post-surgery were evaluated.A statistical analysis of the ablation effect difference between the high-risk site and non-high-risk site groups was conducted.Univariate and multivariate logistic regression analyses were performed to identify risk factors.ResultsBoth groups demonstrated a 100%intraoperative technical success rate,and no major complications related to cryoablation were observed.The complete ablation rate was 82.6%(38/46)and 71.7%(33/46)in the high-risk group and 84.8%(39/46)and 73.9%(34/46)in the non-high-risk group at 12 and 24 months,respectively.There was no significant difference in complete ablation rates between the two groups(P>0.05).Multivariate analysis identified the distance between the tumor edge and high-risk site≤5 mm and preoperative trans-arterial chemoembolization(TACE)treatment as independent risk factors for cryoablation effect.ConclusionCT-guided percutaneous cryoablation is a safe and effective approach for patients with malignant liver tumor at high-risk sites.Our results emphasize the importance of proper preoperative planning and intraoperative manipulation.

关 键 词：肝肿瘤 冷冻疗法 高危部位 有效性 

分 类 号：R735.7[医药卫生—肿瘤]