CAJ | 학술논문

目的：研究经导管肝动脉化疗栓塞术（TACE）联合射频消融（RFA）治疗肝细胞癌（HCC）的安全性、可行性及治疗效果，探讨局部疗效的影响因素。方法2011年8月-2013年6月共10例患者12个HCC病灶行TACE联合RFA治疗，随访至少6个月后，评价疗效并分析其影响因素。结果10例HCC患者共行TACE治疗19次、RFA治疗10次。技术成功率为100%。主要并发症为肝包膜下出血（10%）、疼痛（20%）。住院时间（3.0±1.3）d。治疗后随访（18.0±8.4）个月，靶病灶局部控制率为91.7%（11/12），局部病灶无进展期为（17.0±9.3）个月。TACE治疗后部分病灶缩小，碘油沉积良好，尤其是病灶边缘碘油沉积者，使靶病灶位置、大小更易辨识，有利于后续R FA治疗彻底消融。RFA术后病灶先增大后缩小，术后6个月较术后1个月显著减小（P=0.01）。TACE联合RFA治疗≤3 cm与3~5 cm病灶的局部控制率差异无统计学意义（P＞0.05）。病灶是否靠近肝脏大血管对局部控制率无影响（P＞0.05）。结论TACE联合RFA治疗HCC的安全性、可行性高，治疗3~5 cm的病灶同样可获得较高的肿瘤局部控制率。
목적：연구경도관간동맥화료전새술（TACE）연합사빈소융（RFA）치료간세포암（HCC）적안전성、가행성급치료효과，탐토국부료효적영향인소。방법2011년8월-2013년6월공10례환자12개HCC병조행TACE연합RFA치료，수방지소6개월후，평개료효병분석기영향인소。결과10례HCC환자공행TACE치료19차、RFA치료10차。기술성공솔위100%。주요병발증위간포막하출혈（10%）、동통（20%）。주원시간（3.0±1.3）d。치료후수방（18.0±8.4）개월，파병조국부공제솔위91.7%（11/12），국부병조무진전기위（17.0±9.3）개월。TACE치료후부분병조축소，전유침적량호，우기시병조변연전유침적자，사파병조위치、대소경역변식，유리우후속R FA치료철저소융。RFA술후병조선증대후축소，술후6개월교술후1개월현저감소（P=0.01）。TACE연합RFA치료≤3 cm여3~5 cm병조적국부공제솔차이무통계학의의（P＞0.05）。병조시부고근간장대혈관대국부공제솔무영향（P＞0.05）。결론TACE연합RFA치료HCC적안전성、가행성고，치료3~5 cm적병조동양가획득교고적종류국부공제솔。
Objective To investigate the safety, feasibility, and efficacy of transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) treatment, and to analyze the influencing factors of local efficacy. Methods From August 2011 to June 2013, a series of 10 HCC patients with 12 liver lesions were performed TACE plus RFA. After follow-up of at least 6 months, the efficacy and influencing factors were analyzed. Results A total of 19 TACE and 10 RFA were performed, with technical success rate of 100%. The main complications were bleeding and pain, with rate of 10%and 20%, respectively. The hospital stay were (3.0±1.3) d. After follow-up of (18.0±8.4) months, the local control rate of target lesions was 91.7% (11/12), and the time to local progression was (17.0±9.3) months. Partial of the lesions shrank after TACE. Lesions with good intake of lipiodol, especially in periphery, led to easier identification of the lesion positioning and size, and contributed to the complete ablation followed. After RFA, the lesion size increased at the beginning, then shrank, with significant shrinkage 6-month postablation compared to 1-month postablation. With TACE plus RFA, there was no significant difference in local control between lesions small than 3 cm and 3-5 cm(P>0.05). For lesions smaller than 5 cm, the difference in local control between the perivascular and nonperivascular tumor was not significant(P>0.05). Conclusion The combination of TACE and RFA in hepatocellular carcinoma treatment yields high safety, feasibility and local control, even in the lesions between 3 cm and 5 cm.