超声引导下射频消融治疗肝癌培训项目对患者治疗效果的影响。
Impact of an ultrasound-guided radiofrequency ablation training program on the outcomes in patients with hepatocellular carcinoma.
机构信息
Department of Gastroenterology, Tenri Hospital, Nara, Japan; Third Department of Internal Medicine, Nara Medical University, Nara, Japan.
Department of Gastroenterology, Tenri Hospital, Nara, Japan.
出版信息
Diagn Interv Imaging. 2019 Dec;100(12):771-780. doi: 10.1016/j.diii.2019.08.004. Epub 2019 Aug 30.
PURPOSE
The aim of this study was to retrospectively evaluate the impact of a training program on the safety and efficacy of percutaneous ultrasound-guided radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC).
MATERIALS AND METHODS
A total of 227 patients with 296 HCC nodules who underwent percutaneous RFA with or without transcatheter arterial chemoembolization at our institution were included. There were 163 men and 64 women with a mean age of 74.2±8.3 (SD) years (range: 41-89 years). Percutaneous ultrasound-guided RFA was performed by three trainees (205 HCC nodules in 157 patients) or a mentor (91 HCC nodules in 70 patients) after preprocedural preparation including planning ultrasonography. We compared background-related, tumor-related, and treatment-related factors, and local recurrence and complication rates between the trainee group and the mentor group. Similarly, we compared these variables among the years 2015, 2016, and 2017 for trainee group.
RESULTS
The proportion of easy-to-treat tumors in the trainee group (109/205; 53.2%) was greater than that in the mentor group (33/91; 36.3%) (P=0.020). No significant differences were observed in procedure difficulty among the years 2015, 2016, and 2017 for trainee group (easy-to-treat HCC nodules: 25/47; 53.2% vs. 39/79; 49.4% vs. 45/79; 57.0%. P=0.775). The local recurrence rate in the trainee group was 8.8% (18/205 HCC nodules) which was equivalent to 7.7% in the mentor group (7/91 HCC nodules). No significant differences were observed in local recurrence rate (8.8% vs. 7.7%, respectively; P=0.621) and major complication rate (1.3% vs. 1.4%, respectively; P=0.999) between the trainee group and the mentor group. No significant differences were observed in local recurrence rates ([5/47; 10.6%] vs. [11/79; 13.9%] vs. [2/79; 2.5%]) (P=0.109) and major complication rates ([1/36; 2.8%] vs. [1/62; 1.6%] vs. [0/59; 0%]) (P=0.701) between the years 2015, 2016, and 2017 for trainee group.
CONCLUSION
A well supervised training program that includes planning ultrasonography fosters the efficacy and treatment quality of RFA for HCC.
目的
本研究旨在回顾性评估培训计划对经皮超声引导射频消融（RFA）治疗肝细胞癌（HCC）安全性和疗效的影响。
材料和方法
共纳入 227 例在我院行经皮 RFA 治疗的 296 个 HCC 结节患者。其中男 163 例，女 64 例，平均年龄 74.2±8.3（SD）岁（41-89 岁）。经皮超声引导 RFA 由 3 名学员（157 例患者 205 个 HCC 结节）或导师（70 例患者 91 个 HCC 结节）进行，术前准备包括规划超声。我们比较了学员组和导师组之间的背景相关、肿瘤相关和治疗相关因素以及局部复发和并发症发生率。同样，我们比较了学员组 2015 年、2016 年和 2017 年的这些变量。
结果
学员组易于治疗的肿瘤比例（109/205；53.2%）大于导师组（33/91；36.3%）（P=0.020）。学员组各年手术难度无显著差异（2015 年、2016 年和 2017 年易于治疗的 HCC 结节：25/47；53.2%比 39/79；49.4%比 45/79；57.0%。P=0.775）。学员组局部复发率为 8.8%（205 个 HCC 结节中有 18 个），与导师组的 7.7%（91 个 HCC 结节中有 7 个）相当。学员组和导师组的局部复发率（8.8%比 7.7%；分别为 P=0.621）和主要并发症发生率（1.3%比 1.4%；分别为 P=0.999）无显著差异。学员组各年局部复发率（[5/47；10.6%]比[11/79；13.9%]比[2/79；2.5%]）（P=0.109）和主要并发症发生率（[1/36；2.8%]比[1/62；1.6%]比[0/59；0%]）（P=0.701）无显著差异。
结论
经皮超声引导射频消融治疗 HCC 的疗效和治疗质量可通过包括规划超声的良好监督培训计划来提高。
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