| 摘要: |
| 目的改良经皮微波消融术治疗肝癌的策略与方法,简化治疗过程,提高疗效。方法用冷循环微波消融针治疗原发性肝癌92例(149个结节),平均直径(4.9±3.4) cm。采用不间断消融和环形不间断消融方式分别对直径6 cm以内及以上的瘤体进行消融治疗。瘤体直径4 cm以内,仅用微波消融。瘤体直径4 cm以上,微波消融术前采用肝动脉化疗栓塞(TACE),术中优先消融滋养动脉,6 cm以上瘤体采用环形不间断消融策略并加用双针消融。术后定期增强CT复查评价疗效,并观察1、2、3年生存率。结果一次性完全消融率为76.5%(114/149),二次完全消融率为86.6%(129/149),多次完全消融率为95.3%(142/149)。本组患者1、2、3年累计生存率分别为94.6%(87/92)、72.9%(62/85)、61.4%(35/57)。结论单一微波消融治疗对小肝癌疗效显著；TACE+滋养动脉优先消融+双针消融的组合策略是治疗巨块型肝癌的有效方法；环形不间断消融策略能大幅减少大肝癌消融布点、简化治疗过程,有可能成为追求巨块型肝癌原位灭活的新途径。 |
| 关键词: 肝肿瘤 肝细胞癌 经皮微波消融 不间断消融 环形不间断消融 |
| DOI：10.3724/SP.J.1008.2012.00872 |
| 投稿时间：2012-01-06修订日期：2012-05-08 |
| 基金项目: |
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| A modified percutaneous microwave ablation method for treatment of hepatocellular carcinoma: an observation on clinical therapeutic effects |
| CHEN Jian*,JIN Xia,CHEN Xiao,LIU Hua,YAN Chao-hui,ZHANG Wei-bing,ZHU Ai-ping |
(Department of Ultrasound, Jiangsu Provincial Corps Hospital of Chinese People’s Armed Police Force, Yangzhou 225003, Jiangsu, China
*Corresponding author.) |
| Abstract: |
| ObjectiveTo modify the strategy and methodology of percutaneous microwave ablation for treatment of hepatocellular carcinoma (HCC), so as to simplify the therapeutic process and improve the therapeutic effect. MethodsA total of 92 HCC patients with 149 nodes, with an average diameter of (4.9±3.4) cm, were treated by the newly designed cooling circulation microwave electrode. Continuous ablation was used for tumors with diameters less than 6 cm and ring-shaped continuous ablation was applied for tumors with diameters more than 6 cm. Microwave ablation was used to treat tumors with diameters less than 4 cm. For tumors with diameters more than 4 cm, transcatheter arterial chemoembolization (TACE) was used before microwave ablation and nutrient arteries were given priority for ablation. Ring-shaped continuous ablation strategy and double antenna ablation strategy were adopted for tumors over 6 cm. Enhanced CT scans were performed at regular intervals to evaluate the therapeutic effect and the one-, two- and three-year survival rates were observed. Results(1) The complete necrosis rates for once, twice, and multiple ablations were 76.5%(114/149), 86.6%(129/149) and 95.3%(142/149), respectively. (2) The one-, two- and three-year survival rates in our group were 94.6%(87/92), 72.9%(62/85) and 61.4% (35/57), respectively. ConclusionSingle microwave ablation is effective for small HCC. Double antenna ablation + first ablation of nutrient artery + TACE was effective for huge HCC. Ring-shaped continuous ablation strategy can greatly reduce ablation points and simplify the ablation process, which is probably a new way for in situ complete necrosis of huge HCC. |
| Key words: liver neoplasms hepatocellular carcinoma percutaneous microwave ablation continuous ablation ring-shaped continuous ablation |
