超声引导下肝恶性肿瘤消融治疗：微波与射频消融治疗效果比较
Ultrasound-guided ablative therapy for hepatic malignancies : a comparison of the therapeutic effects of microwave and radiofrequency ablation.
作者信息
Zhang X G, Zhang Z L, Hu S Y, Wang Y L
出版信息
Acta Chir Belg. 2014 Jan-Feb;114(1):40-5.
BACKGROUND
Radiofrequency ablation (RFA) is currently the most widely used thermal ablative technique for unresectable hepatic malignancies. However, microwave ablation (MWA) is also gaining popularity worldwide. With a cooled-tip electrode, MWA produces necrotic effects comparable to RFA without damaging soft tissues along the electrode track. In this study, the authors compared the efficacy of these two ablative modalities in the treatment of primary or secondary liver cancer.
MATERIALS AND METHODS
Ultrasound-guided MWA was employed to treat 230 cases of liver cancer with a total of 349 nodules and a diameter of 0.8-11.4 cm [mean: 5.7 +/- 2.1 cm]. Meanwhile, ultrasound-guided RFA was performed in 92 cases of liver cancer with 173 nodules in total and a diameter of 2.0-10.2 cm [mean: 5.4 +/- 1.9 cm]. The clinical data were retrospectively analyzed to identify the differences between MWA and RFA in terms of their operative safety, local ablative effect, cost efficiency, and cumulative survival rate.
RESULTS
The patient parameters were comparable. The area of coagulative necrosis was similar in both groups. The tumor complete ablation rate was 83.7% (292/349) for the MWA group and 86.7% (150/173) for the RFA group, which showed no significant difference (P = 0.75). The one-year and two-year cumulative survival rate were all comparable between the two groups (P = 0.66, P = 0.41), which were 90.0% (198/220), 81.6% (120/147) for the MWA group, and 91.8% (78/85), 81.0% (34/42) for the RFA group, respectively. Moreover, both the tumor type and number had no influence on survival rate for the two methods. In addition, there was no significant difference in complication rates between the two groups. The cost for performing one MWA procedure was about 40% lower than that of RFA ($1200 vs $2000).
CONCLUSIONS
Both MWA and RFA are safe and effective ablative treatments for liver cancer. Additionally, MWA has the advantage of cost efficiency.
背景
射频消融（RFA）是目前治疗不可切除性肝恶性肿瘤应用最广泛的热消融技术。然而，微波消融（MWA）在全球范围内也越来越受欢迎。采用冷循环电极，MWA产生的坏死效果与RFA相当，且不会沿电极轨迹损伤软组织。在本研究中，作者比较了这两种消融方式治疗原发性或继发性肝癌的疗效。
材料与方法
采用超声引导下MWA治疗230例肝癌患者，共349个结节，直径0.8 - 11.4 cm[平均：5.7±2.1 cm]。同时，对92例肝癌患者进行超声引导下RFA治疗，共173个结节，直径2.0 - 10.2 cm[平均：5.4±1.9 cm]。对临床资料进行回顾性分析，以确定MWA和RFA在手术安全性、局部消融效果、成本效益和累积生存率方面的差异。
结果
患者参数具有可比性。两组的凝固性坏死面积相似。MWA组肿瘤完全消融率为83.7%（292/349），RFA组为86.7%（150/173），差异无统计学意义（P = 0.75）。两组的1年和2年累积生存率均具有可比性（P = 0.66，P = 0.41），MWA组分别为90.0%（198/220）、81.6%（120/147），RFA组分别为91.8%（78/85）、81.0%（34/42）。此外，肿瘤类型和数量对两种方法的生存率均无影响。另外，两组并发症发生率差异无统计学意义。进行一次MWA手术的成本比RFA低约40%（1200美元对2000美元）。
结论
MWA和RFA都是治疗肝癌安全有效的消融方法。此外，MWA具有成本效益优势。
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