中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2012年
2期
155-158
,共4页
肝肿瘤%超声引导%经皮无水酒精注射%射频消融,单极
肝腫瘤%超聲引導%經皮無水酒精註射%射頻消融,單極
간종류%초성인도%경피무수주정주사%사빈소융,단겁
Liver neoplasms%Ultrasound guidence%Percutaneous ethanol injection%Radiofrequency ablation,single needle
目的 探讨超声引导行PEI增效RFA治疗肝癌的近期疗效.方法 回顾性分析2010年6月至2011年6月第四军医大学西京医院收治的71例肝癌患者的临床资料.根据治疗方法将患者分为RFA组(25例)和联合组(46例).RFA组根据肿瘤大小,在超声引导下先将RFA电极置于肿瘤内部消融；联合组则是在超声引导下先向瘤内根据肿瘤大小缓慢注入95％的无水酒精,再迅速行RFA.术后2周超声造影检查评估两组患者肿瘤坏死体积大小,分析联合组术中RFA能量、酒精注射量与肿瘤消融体积之间的关系,观察两组治疗效果.率的比较采用x2检验,组间分析采用两样本的t检验及Pearson等级相关分析.结果 RFA组平均消融体积为(22±17) cm3,明显小于联合组的(55±44) cm3,两组比较,差异有统计学意义(t =3.85,P＜0.05).联合组中,酒精注射量越多肿瘤消融体积越大且呈正相关(r=0.615,t=5.86,P＜0.05)；酒精注射量越多效能越低呈负相关(r=-0.709,t =-7.52,P ＜0.05).RFA能量越大肿瘤消融体积越大且呈正相关(r =0.884,t=14.13,P＜0.05)；RFA能量越大效能也越低,但差异无统计学意义(r=-0.225,t=-1.72,P ＞0.05).推导出酒精注射量的方程式:Y =2.526X-2.693[Y为酒精注射量(ml),X为肿瘤直径(cm)].联合组3例患者在术中出现一过性疼痛,面部潮红,心率加快,经对症处理后,术中生命体征平稳.两组患者术后转氨酶均有不同程度升高,术后2周复查转氨酶均恢复正常.两组患者均未发生肝破裂出血、肠穿孔、胆汁漏及肿瘤种植等严重并发症.两组患者术后AFP值均明显下降,RFA组80％(20/25)的患者完全转为阴性,联合组85％(39/46)的患者完全转为阴性,两组比较,差异无统计学意义(x2 =0.42,P ＞0.05).结论 RFA治疗前行PEI可以增加消融范围,降低RFA效能,提高治疗效果.
目的 探討超聲引導行PEI增效RFA治療肝癌的近期療效.方法 迴顧性分析2010年6月至2011年6月第四軍醫大學西京醫院收治的71例肝癌患者的臨床資料.根據治療方法將患者分為RFA組(25例)和聯閤組(46例).RFA組根據腫瘤大小,在超聲引導下先將RFA電極置于腫瘤內部消融；聯閤組則是在超聲引導下先嚮瘤內根據腫瘤大小緩慢註入95％的無水酒精,再迅速行RFA.術後2週超聲造影檢查評估兩組患者腫瘤壞死體積大小,分析聯閤組術中RFA能量、酒精註射量與腫瘤消融體積之間的關繫,觀察兩組治療效果.率的比較採用x2檢驗,組間分析採用兩樣本的t檢驗及Pearson等級相關分析.結果 RFA組平均消融體積為(22±17) cm3,明顯小于聯閤組的(55±44) cm3,兩組比較,差異有統計學意義(t =3.85,P＜0.05).聯閤組中,酒精註射量越多腫瘤消融體積越大且呈正相關(r=0.615,t=5.86,P＜0.05)；酒精註射量越多效能越低呈負相關(r=-0.709,t =-7.52,P ＜0.05).RFA能量越大腫瘤消融體積越大且呈正相關(r =0.884,t=14.13,P＜0.05)；RFA能量越大效能也越低,但差異無統計學意義(r=-0.225,t=-1.72,P ＞0.05).推導齣酒精註射量的方程式:Y =2.526X-2.693[Y為酒精註射量(ml),X為腫瘤直徑(cm)].聯閤組3例患者在術中齣現一過性疼痛,麵部潮紅,心率加快,經對癥處理後,術中生命體徵平穩.兩組患者術後轉氨酶均有不同程度升高,術後2週複查轉氨酶均恢複正常.兩組患者均未髮生肝破裂齣血、腸穿孔、膽汁漏及腫瘤種植等嚴重併髮癥.兩組患者術後AFP值均明顯下降,RFA組80％(20/25)的患者完全轉為陰性,聯閤組85％(39/46)的患者完全轉為陰性,兩組比較,差異無統計學意義(x2 =0.42,P ＞0.05).結論 RFA治療前行PEI可以增加消融範圍,降低RFA效能,提高治療效果.
목적 탐토초성인도행PEI증효RFA치료간암적근기료효.방법 회고성분석2010년6월지2011년6월제사군의대학서경의원수치적71례간암환자적림상자료.근거치료방법장환자분위RFA조(25례)화연합조(46례).RFA조근거종류대소,재초성인도하선장RFA전겁치우종류내부소융；연합조칙시재초성인도하선향류내근거종류대소완만주입95％적무수주정,재신속행RFA.술후2주초성조영검사평고량조환자종류배사체적대소,분석연합조술중RFA능량、주정주사량여종류소융체적지간적관계,관찰량조치료효과.솔적비교채용x2검험,조간분석채용량양본적t검험급Pearson등급상관분석.결과 RFA조평균소융체적위(22±17) cm3,명현소우연합조적(55±44) cm3,량조비교,차이유통계학의의(t =3.85,P＜0.05).연합조중,주정주사량월다종류소융체적월대차정정상관(r=0.615,t=5.86,P＜0.05)；주정주사량월다효능월저정부상관(r=-0.709,t =-7.52,P ＜0.05).RFA능량월대종류소융체적월대차정정상관(r =0.884,t=14.13,P＜0.05)；RFA능량월대효능야월저,단차이무통계학의의(r=-0.225,t=-1.72,P ＞0.05).추도출주정주사량적방정식:Y =2.526X-2.693[Y위주정주사량(ml),X위종류직경(cm)].연합조3례환자재술중출현일과성동통,면부조홍,심솔가쾌,경대증처리후,술중생명체정평은.량조환자술후전안매균유불동정도승고,술후2주복사전안매균회복정상.량조환자균미발생간파렬출혈、장천공、담즙루급종류충식등엄중병발증.량조환자술후AFP치균명현하강,RFA조80％(20/25)적환자완전전위음성,연합조85％(39/46)적환자완전전위음성,량조비교,차이무통계학의의(x2 =0.42,P ＞0.05).결론 RFA치료전행PEI가이증가소융범위,강저RFA효능,제고치료효과.
Objective To investigate the short-tern efficacy of ultrasound-guided percutaneous ethanol injection (PEI) enhanced single needle radiofrequency ablation ( RFA) in the treatment of liver cancer.Methods The clinical data of 71 patients who were admitted to the Xijing Hospital from June 2010 to June 2011 were retrospectively analyzed.All patients were divided into the RFA group (25 patients ) and RFA + PEI group (46 patients).In the RFA group,the needle of RFA was injected into the tumor for coagulation with the guidence of ultrasound.In the RFA + PEI group,95％ ethanol was injected into the tumor with the guidence of ultrasound,and then RFA was performed.The tumor necrosis volumes of the 2 groups were assessed by contrast-enhanced ultrasound at 2 weeks after RFA.The relationship between the average RFA energy and volume of ethanol applied and necrosis volume was analyzed.All data were analyzed by using the chi-square test,t test and Pearson correlation coefficient.Results The volume of coagulative necrosis of the RFA group was (22 ± 17) cm3,which was significantly smaller than (55 ± 44) cm3 of the RFA + PEI group (t =3.85,P ＜ 0.05 ).In the RFA + PEI group,the volume of ethanol injected was positively correlated with the volume of coagulative necrosis (r =0.615,t =5.86,P ＜ 0.05 ),but negatively correlated with the treatment efficacy ( r =- 0.709,t =- 7.52,P ＜ 0.05 ).The amount of required energy was positively correlated with the volume of coagulative necrosis (r =0.884,t =14.13,P ＜0.05 ),whereas no significant correlation was detected between the amount of required energy and the treatment efficacy ( r =- 0.225,t =- 1.72,P ＞ 0.05 ).The equation for calculating the volume of ethanol required was conducted:Y =2.526X - 2.693 [ Y:volume of ethanol required ( ml),X:diameter of the tumor (cm) ].Three patients in the RFA + PEI group were complicated by transient pain,flushing and cardiac acceleration after the operation,and the symptoms were alleviated by symptomatic treatment.The levels of transaninase were increased in the 3 groups,and then back to normal at 2 weeks after the treatment.No complications such as hepatic rupture,intestinal perforation,bile leakage or tumor implantation were detected in the 2 groups.The levels of alphafetoprotein (AFP) were significantly decreased.The AFP expressions of 20 patients (80％) in the RFA group and 39 patients (85％) in the RFA + PEI group changed to negative,with no significant difference between the 2 groups ( x2 =0.42,P ＞ 0.05 ).Conclusion PEI helps to increase the volume of coagulative necrosis and to reduce the energy requirement of routine RFA,and enhances the efficacy of single needle RFA.
