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目的 探讨对于无再次手术指征的复发性肝癌行B超引导经皮肝穿刺射频热凝(PRFA)治疗的意义。方法 1999年10月-2001年7月经病理证实为原发性肝癌,术后影像学和血清肿瘤标记物证实为肝癌复发的47患者进行B超引导PRFA治疗。复发瘤灶为单发者24例、多发者23例,其中复发灶为单发且小于3.5cm者12例。定期随访,复查AFP、肝功能和B超,1个月后复查MRI或CT了解肿瘤坏死情况,以后每3个月复查。Kaplan-Meier法计算累积生存率。结果 复发灶为单发者1、2、3年的生存率分别为65.2％、37.5％、37.5％,复发灶为单发且小于3.5cm者1、2、3年的生存率分别为83.3％、51.4％、51.4％。复发灶为多发者1、2年的生存率为41.7％、19.5％。结论 B超引导经皮肝穿刺射频热凝是肝癌综合治疗中一种重要手段,对于无再次手术指征的复发性肝癌可以根据复发瘤灶的大小、范围、复发时间,决定单独或结合TACE给予B超引导经皮肝穿刺射频热凝(PRFA)治疗,可以更加有效地控制复发、提高生存率。
Objective To investigate the significance of B-guided percutaneous transhepatic radiofrequency ablation (PRFA) for recurrent hepatocellular carcinoma without re-operation indications. Methods From October 1999 to July 2001, 47 patients with hepatocellular carcinoma proved to be pathologically confirmed by postoperative imaging and serum tumor markers as recurrent hepatocellular carcinoma were treated with B ultrasound guided PRFA. 24 cases of recurrent tumor were single, 23 cases were multiple, of which recurrent lesions were less than 3.5cm and single in 12 cases. Regular follow-up, review AFP, liver function and B-ultrasound, MRI or CT review after 1 month to understand the situation of tumor necrosis, after every 3 months review. Kaplan-Meier method to calculate the cumulative survival rate. Results The survival rates at 1, 2 and 3 years were 65.2%, 37.5% and 37.5%, respectively. The recurrence was single and less than 3.5cm, and the survival rates at 1, 2 and 3 years were 83.3% , 51.4%, 51.4%. Multiple recurrent lesions were 1, 2-year survival rate was 41.7%, 19.5%. Conclusion Ultrasonically guided percutaneous transhepatic radiofrequency thermocoagulation is an important method in the comprehensive treatment of hepatocellular carcinoma. For recurrent hepatocellular carcinoma without re-operation indications, we can decide whether to treat TCC alone or in combination with TACE according to the size, range and recurrence time of recurrent tumor B-guided percutaneous hepatic puncture radiofrequency catheter (PRFA) treatment, can be more effective in the control of recurrence and improve survival.