【摘要】 目的评价CT引导PMCT治疗TACE后原发性肝癌的临床应用。方法对33例确诊为原发性肝癌的病人,先行TACE治疗,2～4周后根据复查的AFP和影像学结果的情况决定再次行TACE或者PMCT。行PMCT治疗的病人,应用“二步法”穿刺:定位后行穿刺道局部麻醉,首先以直径0.6mm、长8cm的腰穿针向肝内病灶穿刺;复查CT,根据骨穿针与病灶的角度和深度,再引入直径2.0mm、长13.5cm的微波天线引导针,针的头端超出病灶边缘约0.5cm,然后引入直径1.6mm的微波天线行微波治疗。所有病人均得到随访,随访时间5～48个月(平均25.5个月),随访的内容包括影像学资料以及并发症。结果33例病人的CT引导下行PMCT治疗TACE后肝癌穿刺成功率100%,病人1-、2-、3-年的累积生存率和复发率分别是84.85%、75.76%、72.73%和9.09%、24.24%、33.33%,出现肝脓肿2例,没有其他严重并发症。PMCT对肝功能的损害轻。结论CT引导下行TACE后肝癌的PMCT操作方便、定位准确,无严重并发症,临床疗效明确,有临床推广应用的价值。更多还原

【Abstract】 Objective To evaluate the clinical application of CT-guided PMCT as a post-TACE treatment for patients with HCC. Methods Thirty-three patients with HCC underwent primary TACE. Then, 2 to 4 weeks later, either TACE or PMCT was planned according to the serum AFP and results of liver imaging such as CT or MR. A two step manipulation was performed in PMCT. In the first step, the mass was punctured with a lumbar-puncture needle, 0.6mm in diameter and 8cm long. In the second step, a guiding-needle of PMCT was reintroduced, which was 2.0mm in diameter and 13.5cm in length. The guiding-needle was placed when its tip went out of the lesion and was 5mm out of the margin of the nidus. CT imaging showed the angle and distance between the lumbar-puncture needle and the mass, monitoring the placement of the guiding needle. The 1.6mm PMCT antenna was finally introduced and then the PMCT was performed. All patients were followed up for 5 and 48 months (averagely 25.5 months). With the results of follow-up, therapeutic effects (evaluated by imaging findings), survival time, complications and recurrence were retrospectively evaluated with statistical analysis. Results The 1, 2 and 3 year survival rate and the recurrence rate of the patients treated by TACE and PMCT were 84.85%, 75.76%, 72.73%and 9.09%, 24.24%, 33.33%, respectively. Liver abscess was found in 2 cases after PMCT, which was the only complication. PMCT led to no other severe complication and made minor damage to the liver function. Conclusion CT-guided PMCT as a post-TACE treatment for patients with HCC is a precise and feasible procedure, which is safe, effective, practical and worth clinic application.更多还原