【作者】 肖冰； 崔生达； 方蓉蓉； 郭文； 陈村龙； 蓝琳； 白岚； 吴保平； 程天明； 姚永莉； 白杨； 刘思德； 张亚历； 智发朝； 张振书； 姜泊；

【Author】 XIAO Bing CUI Shengda FANG Rongrong GUO Wen CHEN Cunlong LAN Lin BAI Lan WU Baoping CHENG Tianming YAO Yongli BAI Yang LIU Side ZHANG Yalig ZHI Fachao ZHANG Zhenshu JIANG Bo Department of Gastroenterology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China

【机构】 南方医科大学南方医院消化科；

【摘要】 目的观察与分析经皮射频消融术(RFA)治疗原发性肝癌的临床疗效和并发症。方法从 2000年1月到2007年6月,B 超引导下对256例原发性肝癌患者行354例次 PRFA,治疗前后行 AFP、 B 超或 CT 检查,治疗后开始随访,最长的随访5年以上。结果 2例治疗后24小时内出现严重并发症而死亡。RFA 术后并发症有:感染、发热223例次(62.99%),肝细胞明显损害117例次(33.05%),黄疸明显加重67例次(18.92%),血性腹水14例次(3.95%),气胸3例次(0.84%),消化道出血2例次(0.56%)。治疗后随访到6个月者187例,AFP 下降50%者129例(68.98%),死亡23例,存活164例(87.70%)。随访到1年者129例,AFP 下降50%者67例(51.93%),死亡37例,存活92例(71.31%)。随访到3 年者83例,AFP 下降50%者28例(37.73%),死亡51例,存活32例(38.55%)。随访到5年者56例, AFP 下降50%者12例(21.42%),死亡44例,存活12例(21.42%)。肝脏肿瘤个数少和病灶体积小或者肝功 child-pugh 分级较好的患者生存率高。结论 RFA 具有简单、微创、安全、有效和反复治疗等优点,尤其对于无手术指征及 TACE 风险较大者,具有更重要的意义。当肿瘤小于5cm 尤其是单个病灶或肝功 child-pugh 分级较好时效果更加明显。但并发症较多,长期疗效有待提高。更多还原

【Abstract】 Objective To evaluate the therapeutic effects and complications of Percutaneous radiofrequency ablation(RFA) for the treatment of Primary Hepatocellular Carcinoma.Methods A total of 256 patients were submitted to Percutaneous RFA under ultrasound guidance for the total frequencies of 354 between January 2001 and June 2007.AFP,B-US,and CT examinations were conducted before and after the operation.A follow-up study was carried out with a maximum period of more than 5 years.Results Two cases were died of severe complications within 24 hours after treatment.Complications of RFA therapy included 223 cases of infection and fever (62.99%),117 cases of severe hepatocyte impaired(33.05%),67 cases of jaundice aggravate(18.92%),14 cases of bloody ascites(3.95%),3 cases of pneumothorax (0.84%)and 2 cases of gastrointestinal hemorrhage(0.56%).We followed up the patients after treatments for 6 months,1 year,3 years and 5 years,the total numbers of patients were 187,129,83,56 respectively,the numbers of patients whose AFP decent to 50% were 129 (68.98%),67(51.93%),and 28(37.73%),and 12 (21.42%) respectively,the numbers of death were 23,37,51,44 respectively,the numbers of survival were 164(87.70%),92(71.31%), 32(38.55%),12(21.42%) tively.Those factors such as less number of tumors,Smaller tumor size and better Child-Pugh class grade are concluded to be improving the survival rate of patients.Condusions RFA therapy is a feasible,minimally invasive,safe,effective and reproducible treatment option,especially for the patients who have no surgical indication and TACE in danger.It can improve the curative effect for tumors size less than 5 cm or getting a better Child-Pugh class grade.However 0 cautions should be taken into consideration when performing RFA on patients brings many complications,and long-term efficacy should be further improved.更多还原