超声引导经皮微波消融治疗邻近血管的原发性肝癌的疗效分析

探讨超声引导经皮微波消融治疗邻近血管的原发性肝癌的疗效。2010年1月至2013年6月期间,回顾性分析在我院采用超声引导下微波消融技术治疗的213例(267个病灶)原发性肝癌患者的病例资料,根据患者病灶位置分为邻近血管组(76例,91个病灶)和对照组(137例,176个病灶),比较两组患者的微波消融次数、微波消融时间、完全消融率、局部肿瘤进展率、累计存活率及并发症。邻近血管组和对照组的原发性肝癌患者消融次数均为1~3次,两组平均微波消融次数无显著差异(p<0.05)。两组微波消融时间为5~28 min,其中邻近血管组显著高于对照组(p>0.05)。微波消融1个月后,邻近血管组的完全消融率与对照组无显著差异(p<0.05)。两组患者在3个阶段(1随访1年,3年和5年)的的局部肿瘤进展率和累计生存率无统计学差异(p<0.05)。两组患者5年随访时间内分别有29例和53例患者死亡。主要死亡原因包括肝癌进展、肝功能衰竭、血管曲张破裂、脑出血、急性肺栓塞、心肌梗死等。邻近血管组共有25例出现术后并发症,对照组有44例。主要并发症类型为腹腔积液、膈疝、出血、肝脓肿、气胸、肝区疼痛和发热。两组之间并发症发生率无统计学意义(p=0.907)。微波消融治疗邻近血管的原发性肝癌具有较好的局部肿瘤控制率,可对邻近血管的危险病灶区域进行有效治疗。

Ultrasound-guided Percutaneous Microwave Ablation for the Treatment of Primary Hepatocellular Carcinoma Adjacent to Blood Vessels

To investigate the efficacy of ultrasound-guided percutaneous microwave ablation in the treatment of primary liver cancer adjacent to blood vessels.from January 2010 to June 2013,retrospective analysis of 213 cases(267 lesions)of primary liver cancer patients treated with ultrasound-guided microwave ablation in our hospital was performed.The patients were divided into adjacent vascular groups(76 cases,91 lesions)and control group(137 cases,176 lesions)according to the location of the lesions.The number of microwave ablation,microwave ablation time,complete ablation rate,local tumor progression rate,cumulative survival rate and complications were compared between the two groups.The number of ablation of primary liver cancer patients in the adjacent vascular group and the control group was 1 to 3 times.There was no significant difference in the average number of microwave ablation between the two groups(p<0.05).The microwave ablation time of the two groups was 5~28 min,and the adjacent vascular group was significantly higher than the control group(p>0.05).After microwave ablation for 1 month,the complete ablation rate of the adjacent vascular group was not significantly different from the control group(p<0.05).There was no significant difference in local tumor progression rate and cumulative survival rate between the two groups(1,3,and 5 years of follow-up)(p<0.05).29 patients in adjacent vascular group and 53 patients in control group died during the 5 year follow-up period.The main causes of death include liver cancer progression,liver failure,variceal rupture,cerebral hemorrhage,acute pulmonary embolism,and myocardial infarction.There were 25 cases of postoperative complications in the adjacent vascular group and 44 cases in the control group.The main types of complications were ascites,fistula,hemorrhage,hepatic abscess,pneumothorax,pain in the liver and fever.There was no statistically significant difference in the incidence of complications between the two groups(p=0.907).Microwave ablation for primary hepatocellular carcinoma with adjacent vessels has a good local tumor control rate and can effectively treat the dangerous lesions of adjacent vessels.