【作者】 刘明； 黄光亮； 谢晓燕； 刘广健； 徐作峰； 郑艳玲； 梁瑾瑜； 陈勉妮； 吕明德；

【Author】 LIU Ming;HUANG Guang-liang;XIE Xiao-yan;LIU Guang-jian;XU Zuo-feng;ZHENG Yan-ling;LIANG Jin-yu;CHEN Mian-ni;Lü Ming-de;Department of Medical Ultrasonics,the First Affiliated Hospital,Sun Yat-Sen University,Guangdong Provincial Center for Diagnostic Ultrasound and Interventional Therapy;

【机构】 中山大学附属第一医院超声介入科；

【摘要】 目的:探讨超声引导下经皮热消融治疗原发于结直肠癌的转移性肝癌(metastatic liver carcinoma,MLC)与原发性肝细胞癌(hepatocellular carcinoma,HCC)局部疗效差异。方法:2004年7月至2011年12月行热消融治疗结直肠癌肝转移69例患者共108个病灶,从同期行热消融治疗且符合纳入标准的原发性肝细胞癌患者中随机选取70例患者共92个病灶。局部疗效比较包括完全消融率(残留率)、局部进展率和局部进展时间,同时观察消融相关并发症和安全边缘的情况。结果:转移性肝癌组(MLC组)与原发性肝癌组(HCC组)比较,肿瘤的完全消融率分别为88.0%和91.3%(P=0.44),局部进展率分别为13.0%和14.1%(P=0.81),中位局部进展时间分别为7.5个月和3.6个月(P=0.36),主要并发症的发生率分别为4.3%和2.9%(P=0.68)。组间比较提示,在相同安全边缘的情况下,MLC组和HCC组的残留率和局部进展率相近。组内比较显示,在MLC组内,安全边缘≤0.5 cm组的残留率显著高于安全边缘≥1.0 cm组与0.5 cm~1.0 cm组。HCC组内,各组安全边缘之间的残留率和局部进展率相近。MLC组内比较,安全边缘≤0.5 cm组的残留率远高于安全边缘>0.5 cm组;在HCC组内,安全边缘≤0.5 cm组的局部进展率高于>0.5 cm组。结论:经皮热消融治疗结直肠癌肝转移和原发性肝癌局部疗效相似,热消融治疗肝脏肿瘤安全、有效。安全边缘达到0.5 cm对减少肿瘤残留和局部进展非常重要。更多还原

【Abstract】 Objective:To investigate the difference of local therapeutic efficacy between colorectal liver metastases and hepatocellular carcinoma with the treatment of ultrasound guided percutaneous thermal ablation.Methods:From July 2004 to December 2011,under the same inclusion criteria,108 nodules of colorectal liver metastases in 69 patients,the tumor diameter ranged from 0.7 cm~6.6 cm(the average diameter was 2.3±1.2 cm),and 92 nodules of hepatocellular carcinoma in 70 patients,the tumor diameter ranged from 0.9cm~7.0 cm(the average diameter was 2.6±1.3 cm),were percutaneously treated with thermal ablation under ultrasound guidance.Comparative analysis of clinical outcomes was performed retrospectively including the complete ablation rates(lesion residual rates),the local tumor progress rates,the local tumor progress time,complications related to treatment and safety margin.Results:The complete ablation rates were 88.0% in colorectal liver metastases group(MLC group) versus 91.3% in hepatocellular carcinoma group(HCC group)(P=0.44),and the local tumor progress rates were 13.0% versus 14.1%(P=0.81),the median time of local tumor progress was 7.5 months versus 3.6 months(P=0.36).The ablation-related major complications were occurred in 3 patients with colorectal liver metastases,and in 2 patients with hepatocellular carcinoma(P=0.68).With the same safety margin,the tumor residual rates and local tumor progress rates of MLC group and HCC group were similar to each other.The comparison of intra-group showed,for the MLC group,there were statistical differences between the safety margin≤0.5 cm and safety margin≥ 1.0 cm as well as 0.5 cm~1.0 cm of lesion residual rates.For the HCC group,the tumor residual rates and local tumor progress rates of different safety margin were similar.When safety margin ≤0.5 cm,the tumor residual rate was much higher than safety margin > 0.5 cm for MLC group.And for HCC group the local tumor progress rate of safety margin ≤0.5 cm was higher than safety margin > 0.5 cm.Conclusion:The complete ablation rates,the local tumor progress rates,and complications related to treatment between patients with colorectal liver metastases and hepatocellular carcinoma are equivalent,and thermal ablation is a safe and effective technique for the treatment of these two liver tumors.A safety margin at least 0.5 cm is important to reduce the residual and local progress of tumor.更多还原