Xu H-X, Xie X-Y, Lu M-D, Chen J-W, Yin X-Y, Xu Z-F, Liu G-J
Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
Clin Radiol. 2004 Jan;59(1):53-61. doi: 10.1016/j.crad.2003.09.006.
To investigate the therapeutic efficacy of thermal ablation for treatment of hepatocellular carcinoma (HCC) using microwave and radiofrequency (RF) energy application.
A total of 190 nodules in 97 patients (84 male, 13 female; mean age 53.4 years, range 24-74 years) with HCC were treated with microwave or RF ablation in the last 4 years. The applicators were introduced into the tumours under conscious analgesic sedation by intravenous administration of fentanyl citrate and droperidol and local anaesthesia in both thermal ablation procedures. The patients were then followed up with contrast-enhanced computed tomography (CT) to evaluate treatment response. Survival was analysed using the Kaplan-Meier method.
Complete ablation was obtained in 92.6% (176/190) nodules. The complete ablation rates were 94.6% (106/112) in microwave ablation and 89.7% (70/78) in RF ablation. The complete ablation rates in tumours</=2.0, 2.1-3.9 and >/=4.0 cm were 93.1, 93.8 and 86.4%, respectively. Local recurrence was found in 9.5% nodules and the rates in tumours</=2.0, 2.1-3.9 and >/=4.0 cm in diameter were 3.4, 9.9 and 31.8%, respectively. In the follow-up period, 7.1% nodules ablated by microwave and 12.8% by RF presented local recurrence. The 1, 2 and 3-year distant recurrence-free survivals were 47.2, 34.9 and 31.0%, respectively. Estimated mean survival was 32 months, and 1, 2 and 3-year cumulative survivals were 75.6, 58.5, and 50.0%, respectively. One and 2 years survivals of Child-Pugh class A, B and C patients were 83.8 and 70.4%, 78.2 and 53.2%, 36.3 and 27.3%, respectively.
Thermal ablation therapy by means of microwave and RF energy application is an effective and safe therapeutic technique for hepatocellular carcinoma. Large tumours can be completely ablated, but have a significantly higher risk of local recurrence at follow-up.
探讨应用微波和射频能量进行热消融治疗肝细胞癌（HCC）的疗效。
在过去4年中，对97例（84例男性，13例女性；平均年龄53.4岁，范围24 - 74岁）肝细胞癌患者的190个结节进行了微波或射频消融治疗。在两种热消融手术中，通过静脉注射枸橼酸芬太尼和氟哌利多进行清醒镇痛镇静，并给予局部麻醉，将消融针插入肿瘤内。然后对患者进行对比增强计算机断层扫描（CT）随访，以评估治疗反应。采用Kaplan-Meier方法分析生存率。
92.6%（176/190）的结节实现了完全消融。微波消融的完全消融率为94.6%（106/112），射频消融的完全消融率为89.7%（70/78）。直径≤2.0 cm、2.1 - 3.9 cm和≥4.0 cm的肿瘤的完全消融率分别为93.1%、93.8%和86.4%。9.5%的结节出现局部复发，直径≤2.0 cm、2.1 - 3.9 cm和≥4.0 cm的肿瘤的复发率分别为3.4%、9.9%和31.8%。在随访期间，微波消融的结节中有7.1%出现局部复发，射频消融的结节中有12.8%出现局部复发。1年、2年和3年的远处无复发生存率分别为47.2%、34.9%和31.0%。估计平均生存期为32个月，1年、2年和3年的累积生存率分别为75.6%、58.5%和50.0%。Child-Pugh A级、B级和C级患者的1年和2年生存率分别为83.8%和70.4%、78.2%和53.2%、36.3%和27.3%。
应用微波和射频能量进行热消融治疗是一种治疗肝细胞癌的有效且安全的技术。大肿瘤可以实现完全消融，但随访时局部复发风险显著更高。
