CAJ | 학술논문

目的评价射频消融术(RFA)联合肝动脉化疗栓塞术(TACE)对于肝转移癌的治疗效果.方法搜集2005年3月至2010年10月36例肝转移癌患者的临床资料进行分析,其中男22例,女14例;年龄42～82岁,平均(63±12)岁;肿瘤最大径1.5～12.0 cm,平均(4.5±2.4) cm.其中单发转移灶29例,多发转移7例,共47个病灶.患者均为全身化疗失败或无法耐受,且无其他脏器转移证据者.术前CT扫描,对于富血供者先行TACE,术后3周内行RFA;对于乏血供者,先行RFA,术后3周内行TACE.对于多个病灶,采取分次逐一治疗.术后每个月行B超复查及肝功能、血象、肿瘤标记物检查,每3个月行腹部CT增强扫描1次.对于随访过程中肿瘤的局部残存及复发,在可能的前提下仍行RFA+TACE治疗.根据治疗后的影像表现分为病灶完全消融组和病灶部分消融组2个亚组,完全消融组不再进行任何治疗,定期随访观察;部分消融组如无法行进一步RFA治疗,则根据患者情况定期行TACE治疗.随访终点事件为患者死亡.对所有患者的整体生存期及两个亚组的生存期采用SPSS 18.0统计分析软件,Kaplan-Meier方法进行统计分析.结果 RFA全部采用经皮途径在局部麻醉结合静脉基础麻醉下完成,无严重并发症发生.16例患者经过1次或多次联合治疗后达到局部病灶完全消除(病灶完全消融组);20例患者病灶部分消除(病灶部分消融组).随访时间10～40个月,平均(25±10)个月.死亡23例,至今存活13例.中位生存期27个月(95%可信区间:24～32个月).至观察终点1、2、3年生存率分别为91.7%(33/36例)、55.5%(20/36例)、36.1%(13/36例).病灶完全消融组和部分消融组的3年生存率分别为75.0%(12/16例)和5.0%(1/20例),差异有统计学意义(P<0.01).结论 RFA+TACE可以有效控制肝转移癌患者肝内病变的进展,延长患者生存期.争取病灶的完全消融是提高疗效的关键.
목적 평개사빈소융술(RFA)연합간동맥화료전새술(TACE)대우간전이암적치료효과.방법 수집2005년3월지2010년10월36례간전이암환자적림상자료진행분석,기중남22례,녀14례;년령42～82세,평균(63±12)세;종류최대경1.5～12.0 cm,평균(4.5±2.4) cm.기중단발전이조29례,다발전이7례,공47개병조.환자균위전신화료실패혹무법내수,차무기타장기전이증거자.술전CT소묘,대우부혈공자선행TACE,술후3주내행RFA;대우핍혈공자,선행RFA,술후3주내행TACE.대우다개병조,채취분차축일치료.술후매개월행B초복사급간공능、혈상、종류표기물검사,매3개월행복부CT증강소묘1차.대우수방과정중종류적국부잔존급복발,재가능적전제하잉행RFA+TACE치료.근거치료후적영상표현분위병조완전소융조화병조부분소융조2개아조,완전소융조불재진행임하치료,정기수방관찰;부분소융조여무법행진일보RFA치료,칙근거환자정황정기행TACE치료.수방종점사건위환자사망.대소유환자적정체생존기급량개아조적생존기채용SPSS 18.0통계분석연건,Kaplan-Meier방법진행통계분석.결과 RFA전부채용경피도경재국부마취결합정맥기출마취하완성,무엄중병발증발생.16례환자경과1차혹다차연합치료후체도국부병조완전소제(병조완전소융조);20례환자병조부분소제(병조부분소융조).수방시간10～40개월,평균(25±10)개월.사망23례,지금존활13례.중위생존기27개월(95%가신구간:24～32개월).지관찰종점1、2、3년생존솔분별위91.7%(33/36례)、55.5%(20/36례)、36.1%(13/36례).병조완전소융조화부분소융조적3년생존솔분별위75.0%(12/16례)화5.0%(1/20례),차이유통계학의의(P<0.01).결론 RFA+TACE가이유효공제간전이암환자간내병변적진전,연장환자생존기.쟁취병조적완전소융시제고료효적관건.
Objective To investigate the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) for treating of hepatic metastasis. Methods From Mar. 2005 to Oct. 2010, 22 males and 14 females with hepatic metastasis were enrolled in this study. Mean age of the patients was 63±12 (42-82) years. Tumor size was (4.5±2.4) cm (min.1.5 cm, max. 12.0 cm). Totally 47 lesions were treated with single metastasis in 29 cases and multiple ones in 7 cases. All cases were failed to chemotherapy or could not stand for the side effect of chemotherapy. Contrast enhanced CT scan was given to all patients before RFA+TACE. For lesions with rich blood supply, TACE was given and then RFA. For those with poor blood supply, RFA was given first and then TACE. For multiple lesions, RFA+TACE was given one by one for each lesion. As for follow up, ultrasound and blood check was given monthly. Enhanced CT scan was given every 3 month. For residual lesions or recurrent lesions, RFA+TACE were given repeatedly. The whole patients was divided into two groups according to the image follow up including complete ablation group and partial ablation group. For complete ablation group, no further treatment was given. For partial ablation group, if it was not suitable for further RFA, repeated TACE was given there after. The end point of follow up was death event. Survival of the whole group and the two subgroups was analyzed statistically by Kaplan-Meier method. Results All RFA procedures was given under intravenous anesthesia and local anesthesia, no severe complication was noted. Lesions in 16 patients were completely ablated after single or multiple sections of RFA+TACE. Twenty patients were in the partially ablated group. Follow up time was 25±10 (10-40) months. Twenty-three patients died and 13 kept alive during the follow up time. The estimated median survival time was 27 month (95%CI: 24-32 months). Survival ration at 1, 2, 3 years for the whole group was 91.7%(33/36),55.5%(20/36),36.1%(13/36) for the whole group. The 3 years survival for complete and partial ablation group was 75.0%(12/16),5.0%(1/20),there was a significant difference between the two groups(P<0.01). Conclusion For patients with hepatic metastasis, RFA+TACE can effectively control the local lesion. Complete ablation is the key point for a better survival.