CAJ | 학술논문

目的评价肝动脉化疗栓塞(TACE)联合CT引导下射频消融治疗特殊部位小肝癌的安全性和疗效.方法 2008年6月至2011年12月在中山大学附属第三医院行TACE联合CT引导下射频消融治疗并随访时间超过6个月的36例小肝癌患者.按肿瘤部位,分为特殊部位组(肿瘤位于肝包膜下、肝门区、大血管或重要脏器旁)20例,非特殊部位组16例.所有患者均在TACE后4～6周行射频消融术,联合治疗后1个月随访CT或MRI增强检查,评价肿瘤完全消融率,此后每1～3个月随访CT或MRI增强检查,评价局部肿瘤进展.比较两组患者并发症发生率、肿瘤完全消融率、局部肿瘤进展率及至肿瘤进展时间(TTP).结果特殊部位组20例22个病灶,共行TACE 24次,消融治疗26次；非特殊部位组16例17个病灶,共行TACE18次,消融治疗17次.并发症:特殊部位组发生率为46.2％ (12/26),其中严重并发症1例,为左心衰,轻微并发症11例,包括血管损伤6例,肝包膜下出血3例,肝动-静脉瘘2例；非特殊部位组发生率为17.6％(3/17)(P=0.101),均为轻微并发症,包括肝包膜下出血l例、肝动-静脉瘘2例.特殊部位组肿瘤完全消融率为68.2％ (15/22),而非特殊部位组为100％(17/17)(P=0.012).特殊部位组6个月、1、2、3年局部肿瘤进展率分别为31.8％、40.9％、45.5％、45.5％,平均TTP为14.4个月；而非特殊部位组6个月、1、2、3年局部肿瘤进展率分别为0、0、0、5.9％,平均TTP为31.5个月,两组比较差异有统计学意义(P =0.001).结论 TACE联合CT引导下射频消融治疗特殊部位小肝癌安全、可行,但术后局部肿瘤进展率较高,需要密切的影像学随访,及时发现肿瘤残留或复发.
목적 평개간동맥화료전새(TACE)연합CT인도하사빈소융치료특수부위소간암적안전성화료효.방법 2008년6월지2011년12월재중산대학부속제삼의원행TACE연합CT인도하사빈소융치료병수방시간초과6개월적36례소간암환자.안종류부위,분위특수부위조(종류위우간포막하、간문구、대혈관혹중요장기방)20례,비특수부위조16례.소유환자균재TACE후4～6주행사빈소융술,연합치료후1개월수방CT혹MRI증강검사,평개종류완전소융솔,차후매1～3개월수방CT혹MRI증강검사,평개국부종류진전.비교량조환자병발증발생솔、종류완전소융솔、국부종류진전솔급지종류진전시간(TTP).결과 특수부위조20례22개병조,공행TACE 24차,소융치료26차；비특수부위조16례17개병조,공행TACE18차,소융치료17차.병발증:특수부위조발생솔위46.2％ (12/26),기중엄중병발증1례,위좌심쇠,경미병발증11례,포괄혈관손상6례,간포막하출혈3례,간동-정맥루2례；비특수부위조발생솔위17.6％(3/17)(P=0.101),균위경미병발증,포괄간포막하출혈l례、간동-정맥루2례.특수부위조종류완전소융솔위68.2％ (15/22),이비특수부위조위100％(17/17)(P=0.012).특수부위조6개월、1、2、3년국부종류진전솔분별위31.8％、40.9％、45.5％、45.5％,평균TTP위14.4개월；이비특수부위조6개월、1、2、3년국부종류진전솔분별위0、0、0、5.9％,평균TTP위31.5개월,량조비교차이유통계학의의(P =0.001).결론 TACE연합CT인도하사빈소융치료특수부위소간암안전、가행,단술후국부종류진전솔교고,수요밀절적영상학수방,급시발현종류잔류혹복발.
Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus computed tomography (CT)-guided percutaneous radiofrequency ablation (RFA) for small hepatocellular carcinoma (HCC) in special locations.Methods From June 2008 to December 2011,a total of 36 patients with small HCC (39 lesions) received TACE plus CT-guided percutaneous RFA at our hospital.The follow-up period was over 6 months.They were divided into 2 groups according to the locations of HCC:special location (located at hepatic subcapsular,portal area,next to large blood vessels or other organs) and non-special location groups.All patients underwent TACE at one month pre-RFA.Follow-up imaging with enhanced computed tomography (CT) or magnetic resonance imaging (MRI) was performed one month after combined treatment to evaluate the complete ablation rate in two groups.If a complete ablation was achieved,enhanced CT or MRI was performed every 1-3 months to evaluate the local tumor progression.The occurrence rate of complications,complete ablation rate,local tumor progression and time to tumor progression (TTP) were compared between two groups.Results In the special location group,a total of 24 TACE and 26 ablations were performed in 20 patients with 22 lesions while there were 18 TACE and 17 ablations in 16 patients with 17 lesions in the non-special location group.In the special location group,12 patients (46.2％) suffered procedure-related complications,including a major complication (n =1,left ventricular failure) and a minor complication (n =11) of vascular injury (n =6),subcapsular hemorrhage (n =3) and arterial-portal vein fistula (n =2) ; whereas only 3 patients (17.6％) suffered a minor complication of subcapsular hemorrhage (n =1) and arterial-portal vein fistula (n =2) in the special location group.The occurrence rate of complications was similar between two groups (P =0.101).The complete ablation rate after one month was 68.2％ (15/22) in the special location group and it was significantly higher than that of the non-special location group (100％,P =0.012).In the special location group,the 6-month,1-,2-,3-year local tumor progression rates were 31.8％,40.9％,45.5％,45.5％ versus 0,0,0,5.9％ in the non-special location group respectively.The mean TTP of 14.4 months in the special location group was markedly shorter than that in the non-special location group (31.5 months,P =0.001).Conclusion The combined regimen of TACE and percutaneous RFA is both safe and feasible for small HCC in special location.And the rate of local tumor progression is significantly higher than that of non-special location tumor.Postoperative close imaging follow-up is needed for tumor residue or recurrence.