【摘要】 目的 探讨经皮肝穿刺射频热凝治疗肝癌的意义、适应证和疗效评价标准。方法 1999年10月～2000年10月,100例肝脏恶性肿瘤患者进行了B超引导经皮肝穿刺射频热凝治疗。患者治疗后每个月进行了血清肿瘤标记物检测、B超检查,治疗后1个月复查MRI。结果 患者肝功能Child A组67例,Child B组29例,Child C组4组。原发性肝癌76例,转移性肝癌24例。小肝癌(未手术,肿瘤直径≤5 cm)甲胎蛋白阳性者治疗后甲胎蛋白转阴占75.0％(21/28),明显下降占21.4％(6/28)。B超复查肿瘤缩小、MRI或 CT提示≤5 cm肿瘤完全凝固性坏死率85.9％(61/71)。结论 经皮肝穿刺射频热凝(PRFA)作为肿瘤透热治疗的一种力法,对于小肝癌尤其是无手术指征,或有手术指征但位于肝中央区、临近腔静脉或肝门区的小肝癌,是一种微创、时间短、安全方便、疗效可靠的新方法。对于大肝癌,PRFA可与肝动脉介入化疗栓塞联合应用,提高疗效。更多还原

【Abstract】 Objective To study the therapeutic efficay of percutaneous radiofrequency ablation (PRFA) for hepatic malignancies and to define its indications and its criteria of the curative effect.Methods In 100 patients with histologicallly or clinically confirmed hepatocellular carcinoma (HCC) or liver metastases we performed PRFA under ultrasound guidance using LeVeen multipolar array needle electrode and RF 2000 generator. All patients were followed to identify complications and to assess treatment response.Results PRFA was performed in 76 patients with HCC and in 24 with liver metastases. The Alpha-fetoprotein (AFP) levels of the AFP positive HCC patients with inoperable small HCCs decreased to normal in 75. 0% (21/28) and decreased markedly in 21.4% (6/28). Complete necrosis of small hepatic malignancies, documented by magnetic resonance imaging (MRI) was a-chieved in 85.9% (61/71). If the tumor shows iso- or hyper-intensity on Tl-weighted images, and relative hypointensity on T2-weighted images, and no enhanced intensity on dynamic contrast-enhanced MR imaging, it is considered completely coagulated. Conclusion PRFA is a novel local thermal palliative therapy for small hepatic malignancies that is minimally invasive, safe and effective. In patients with large lesions it can be combined with transarterial chemoembolization (TACE). Critera for curative treatment are normalization of serum AFP and/or MRI or CT scan findings showing complete necrosis.更多还原