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经肝动脉化疗栓塞术序贯双极针射频消融治疗高危部位肝细胞癌的效果观察
Clinical effect of sequential therapy with transarterial chemoembolization and bipolar-needle radiofrequency ablation in treatment of hepatocellular carcinoma in high-risk locations
文章发布日期:2018年06月07日  来源:  作者:梁宏元,郭启勇,毛晓楠,等  点击次数:465次  下载次数:67次

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【摘要】:目的 探讨经肝动脉化疗栓塞术(TACE)序贯双极针射频消融(RFA)治疗高危部位肝细胞癌(HCC)的临床应用。方法 收集2014年1月-2015年6月于中国医科大学附属盛京医院就诊的初治高危部位HCC患者,首先实施TACE治疗,15~60 d后联合CT引导的双极针RFA序贯治疗。术后随访2~36个月,评价临床疗效。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验或Fisher精确概率法。采用Kaplan-Meier法进行生存分析。结果 共纳入35例HCC患者,40枚病灶,行TACE和双极针RFA序贯治疗,技术成功率为100%。最大直径≤3 cm的病灶完全消融率为100%(28/28),高于病灶最大直径>3 cm的完全消融率66.7%(8/12)(P=0.005)。随访至2017年6月,中位生存时间为27.6个月,1、2年生存率分别为94.3%、65.7%。靠近被膜的病灶完全消融率高于其他高危部位病灶的完全消融率(95% vs 85%),且并发症发生率更低(15% vs 35%),但差异均无统计学意义(P值均>0.05)。碘油沉积超过50%的病灶平均消融时间为(24.2±6.7)min,碘油沉积低于50%的病灶平均消融时间为(30.1±10.2)min,差异有统计学意义(t=2.163,P=0.037)。所有患者未见严重并发症,轻度并发症包括被膜下少量出血3例、腹腔少量出血1例、皮下血肿1例、少量气胸伴腹腔少量出血1例、少量气胸2例、少量血胸2例,上述并发症经保守治疗后均缓解。结论 TACE联合CT引导双极针RFA序贯治疗高危部位HCC是一种安全、有效的方法,与其他高危部位相比,被膜下病灶可能治疗效果更佳。
【Abstract】:Objective To investigate the clinical effect of sequential therapy with transarterial chemoembolization (TACE) and bipolar-needle radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) in high-risk locations. Methods A total of 35 previously untreated patients with HCC in high-risk locations who visited Shengjing Hospital of China Medical University from January 2014 to June 2015 were enrolled. They were given TACE for 15-60 days, followed by CT-guided bipolar-needle FRA. The patients were followed up for 2-36 months after surgery, and the clinical outcomes were evaluated. The t-test was used for comparison of continuous data between groups, and the chi-square test or Fisher′s exact test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for survival analysis. Results A total of 35 HCC patients with 40 lesions were enrolled and given the sequential therapy with TACE and bipolar-needle RFA, and the technical success rate was 100%. The lesions with a maximum diameter of ≤3 cm achieved a complete ablation rate of 100% (28/28), and those with a maximum diameter of >3 cm achieved a complete ablation rate of 66.7% (8/12); there was a significant difference between these two groups (P=0.005). The patients were followed up to June 2017; the median survival time was 27.6 months, and the 1- and 2-year survival rates were 94.3% and 65.7%, respectively. The lesions close to the capsule had a higher complete ablation rate than those in other locations (95% vs 85%, P>0.05), as well as a lower incidence rate of complications (15% vs 35%, P>0.05). There was a significant difference in mean ablation time between the lesions with >50% lipiodol deposition and those with <50% lipiodol deposition (24.2±6.7 min vs 30.1±10.2 min, t=2.163, P=0.037). No patients experienced serious complications; mild complications included slight subcapsular hemorrhage in three patients, slight abdominal hemorrhage in one patient, subcutaneous hematoma in one patient, mild pneumothorax with slight abdominal hemorrhage in one patient, mild pneumothorax in two patients, and mild hemothorax in two patients, and all these complications were relieved after conservative treatment. Conclusion Sequential therapy with TACE and CT-guided bipolar-needle RFA is safe and effective in patients with HCC in high-risk locations, and may have a better therapeutic effect on subcapsular lesions than on the lesions in other high-risk locations.
【关键字】:癌,肝细胞;化学栓塞,治疗性;导管消融术;治疗结果
【Key words】:carcinoma, hepatocellular; chemoembolization, therapeutic; catheter ablation; treatment outcome
【引证本文】:LIANG HY, GUO QY, MAO XN, et al. Clinical effect of sequential therapy with transarterial chemoembolization and bipolar-needle radiofrequency ablation in treatment of hepatocellular carcinoma in high-risk locations[J]. J Clin Hepatol, 2018, 34(7): 1462-1469. (in Chinese)
梁宏元, 郭启勇, 毛晓楠, 等. 经肝动脉化疗栓塞术序贯双极针射频消融治疗高危部位肝细胞癌的效果观察[J]. 临床肝胆病杂志, 2018, 34(7): 1462-1469.

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