Chen Min-hua, Yang Wei, Yan Kun, Gao Wen, Dai Ying, Wang Yan-bin, Huo Ling, Zhang Hui, Huang Xin-fu
Department of Ultrasound, Oncology School, Peking University, Beijing 100036, China.
Zhonghua Yi Xue Za Zhi. 2005 Jul 6;85(25):1741-6.
To investigate the role of standard treatment with ultrasound-guided radiofrequency ablation (RFA) in improving the treatment level of liver malignancies.
302 patients with 476 liver malignancies were treated with established protocol and adjuvant measures and subjected to efficiency analysis. In the 302 patients, 181 had 282 hepatocellular carcinomas (HCC) with a mean diameter of 4.2 cm, and 121 had 194 metastatic liver carcinomas (MLC) with a mean diameter of 3.9 cm. According to UICC-TNM system 50 patients (27.6%) were in stage I/II and 131 (72.4%) in stage III/IV (including 39 patients with recurrent HCC after surgical resection). A standard protocol and an individualized protocol were used to treat the tumors based on their size, shape and special location such as the distance from diaphragm, gallbladder and gastrointestinal tract. Needle placement method and operation skill for the tumor region adjacent to important structures were described. Some adjuvant measures such as supplementary fine needle localization, local saline injection and feeding vessel ablation were used to improve RFA efficacy in tumors with different features. Local ablation of bleeding site and haemostatic administration systemically were adopted to deal with bleeding. For the patients with tumor adjacent to gastrointestinal tract, prolonged fasting after the RFA procedure was required. the patients were followed up regularly to assess the treatment efficiency, and the tumor was considered complete necrosed if no viability was found on enhanced CT or enhanced US one month after RFA.
The tumor necrosis rate was 95.7% (270/282 tumors) for HCC, 94.8% (184/194 tumors) for MLC, 91.1% (51/56 tumors) for tumor near gastrointestinal tract, 88.5% (69/78 tumors) for tumors near diaphragm, and 94.3% (49/52 tumors) for tumor near gallbladder. The local recurrence rate was 10.3% (29/282 tumors) for HCC and 14.4% (28/194 tumors) for MLC. The 1, 2 and 3 year overall survival rates were 87.6%, 67.4% and 58.6% in the HCC patients, and 87.4%, 48.2%, 25.3% in the MLC patients respectively. The 1, 2 and 3 year survival rates of 50 HCC patients in early (I-II) stages were 90.7%, 85.9% and 73.7%, respectively. The incidence of complications was 2.2% (13/583 sessions), including 5 cases of hemorrhage, 1 case colon perforation, 8 cases of injury of adjacent structures.
Application of proper protocol and adjuvant measures plays an important role in improving tumor ablation rate. Knowledge about possible complications and their control may increase the treatment efficacy and help to promote the use of RFA technique.
探讨超声引导下射频消融（RFA）标准治疗在提高肝脏恶性肿瘤治疗水平中的作用。
对302例共476个肝脏恶性肿瘤患者采用既定方案及辅助措施进行治疗，并进行疗效分析。302例患者中，181例有282个肝细胞癌（HCC），平均直径4.2 cm；121例有194个转移性肝癌（MLC），平均直径3.9 cm。根据国际抗癌联盟（UICC）-TNM系统，50例（27.6%）为Ⅰ/Ⅱ期，131例（72.4%）为Ⅲ/Ⅳ期（包括39例手术切除后复发的HCC患者）。根据肿瘤的大小、形状及特殊位置如距膈肌、胆囊和胃肠道的距离，采用标准方案和个体化方案治疗肿瘤。描述了与重要结构相邻肿瘤区域的进针方法和操作技巧。采用一些辅助措施如辅助细针定位、局部注射生理盐水及供血血管消融，以提高不同特征肿瘤的RFA疗效。采用局部出血部位消融及全身止血给药处理出血。对于肿瘤邻近胃肠道的患者，RFA术后需延长禁食时间。定期对患者进行随访以评估治疗效果，若RFA术后1个月增强CT或增强超声检查未发现肿瘤存活，则认为肿瘤完全坏死。
HCC的肿瘤坏死率为95.7%（270/282个肿瘤），MLC为94.8%（184/194个肿瘤），邻近胃肠道肿瘤为91.1%（51/56个肿瘤），邻近膈肌肿瘤为88.5%（69/78个肿瘤），邻近胆囊肿瘤为94.3%（49/52个肿瘤）。HCC的局部复发率为10.3%（29/282个肿瘤），MLC为14.4%（28/194个肿瘤）。HCC患者1年、2年和3年总生存率分别为87.6%、67.4%和58.6%，MLC患者分别为87.4%、48.2%、25.3%。50例早期（Ⅰ-Ⅱ期）HCC患者1年、2年和3年生存率分别为90.7%、85.9%和73.7%。并发症发生率为2.2%（13/583次治疗），包括5例出血、1例结肠穿孔、8例邻近结构损伤。
应用合适的方案及辅助措施对提高肿瘤消融率起重要作用。了解可能的并发症及其处理方法可提高治疗效果，有助于推广RFA技术的应用。
