经皮及术中超声引导下肝肿瘤射频消融术

Stang A, Keles H, von Seydewitz C, Hentschke S, Malzfeldt E, Teichmann W, Braumann D

2. Medizinische Abteilung, Allgemeines Krankenhaus Altona, Hamburg, Germany.

Ultraschall Med. 2007 Apr;28(2):181-8. doi: 10.1055/s-2006-927263.

PURPOSE

Ultrasonography (US)-guided Radiofrequency ablation (RFA) is increasingly used to treat liver tumours. The aim of this study was to evaluate the impact of multidisciplinary patient selection on clinical results.

MATERIALS AND METHODS

From January 2002 to December 2004, 69 consecutive patients with malignant hepatic tumours were presented to our clinic for RFA-treatment. After a multidisciplinary tumour board decision, 33 patients (47.8%) with 70 liver tumours underwent RFA using a 14-gauge needle electrode via a percutaneous (26) or surgical (7) approach, either alone or combined with resection (3) or chemoembolisation (3). 36 patients (52.2%) were excluded from RFA treatment, mainly because of extensive disease or failure of prior chemotherapy. With a median of 20 months (range 6 - 42 months), all 69 patients were followed clinically to assess survival, and the 33 patients who received additional treatment were examined by contrast-enhanced CT to assess local success.

RESULTS

Complete necrosis was obtained in 64/70 of ablated tumours (91.4%).The corresponding mean sizes (ranges) of lesion vs. necrosis achieved were 2.3 cm (0.9 - 5.0) vs. 3.7 cm (2.1 - 5.7). Two complications (6.6%) occurred, including one liver abscess and one postablational syndrome. At the time of the tumour board decision, the RFA (33) and non-RFA (36) group differed in mean sizes of tumours (2.3 vs. 3.5 cm), average tumours per patient (2.1 vs. 3.8), and failure of prior chemotherapy (2/33 vs. 22/36). From 36 patients judged to be ineligible for RFA, 24 (66.6%) underwent RFA at another institution. When comparing survival of patients who underwent RFA at our institution (33) vs. those who underwent RFA outside (24) vs. those who underwent no RFA (12), 1/33 (3%) vs. 9/24 (37.5%) vs. 8/12 (66.6%) died within 6 month and 27/33 (81.2%) vs. 5/24 (29.2%) vs. 2/12 (16.7%) were alive after 20 months median follow up.

CONCLUSION

US-guided RFA offers a safe local treatment option to destroy small liver tumours (< 3 cm). Carefully and multidisciplinary selected patients may derive benefit, but uncritical application leads to unsatisfying clinical results.

目的

超声（US）引导下的射频消融（RFA）越来越多地用于治疗肝肿瘤。本研究的目的是评估多学科患者选择对临床结果的影响。

材料与方法

2002年1月至2004年12月，69例连续性恶性肝肿瘤患者到我院接受RFA治疗。经过多学科肿瘤委员会的决定，33例（47.8%）患有70个肝肿瘤的患者通过经皮（26例）或手术（7例）途径，使用14号针电极进行RFA，单独进行或与切除术（3例）或化疗栓塞术（3例）联合进行。36例（52.2%）患者被排除在RFA治疗之外，主要原因是疾病广泛或先前化疗失败。所有69例患者均进行了中位时间为20个月（范围6 - 42个月）的临床随访以评估生存情况，对33例接受额外治疗的患者进行了对比增强CT检查以评估局部成功率。

结果

70个消融肿瘤中有64个（91.4%）实现了完全坏死。消融灶与坏死灶的相应平均大小（范围）分别为2.3 cm（0.9 - 5.0）和3.7 cm（2.1 - 5.7）。发生了2例并发症（6.6%），包括1例肝脓肿和1例消融后综合征。在肿瘤委员会做出决定时，RFA组（33例）和非RFA组（36例）在肿瘤平均大小（2.3 vs. 3.5 cm）、每位患者平均肿瘤数（2.1 vs. 3.8）以及先前化疗失败情况（2/33 vs. 22/36）方面存在差异。在36例被判定不适合RFA的患者中，24例（66.6%）在另一机构接受了RFA。比较在我院接受RFA的患者（33例）、在院外接受RFA的患者（24例）和未接受RFA的患者（12例）的生存情况，6个月内死亡的比例分别为1/33（3%）、9/24（37.5%）和8/12（66.6%），中位随访20个月后存活的比例分别为27/33（81.2%）、5/24（29.2%）和2/12（16.7%）。