胃癌肝转移术中射频消融治疗的临床意义

目的：评估胃癌根治术同时性射频消融治疗在治疗胃癌肝转移的临床意义。方法：收集2008年1月至2010年12月19例胃癌肝转移患者，合计转移灶33个，转移灶小于4厘米，且合计不超过4个转移灶。射频消融治疗在术中超声引导下完成。Kap-lan—Meier法分析无病生存期，无肝转移生存期及总生存期。对临床病理学因子及肝转移相关因子采用Log-rank法Cox风险比例模型解析。结果：中位无病生存、无肝转移生存及总生存期为355，394及488天。有3例患者获得长期的无复发生存。单因素分析显示，较早的T分期、N分期，较少的转移灶数量，较小的转移灶直径与良好的预后相关。多因素分析提示，病灶数量与病灶直径为独立预后因子。结论：肝转移射频消融治疗安全性好，对单发的小于4cm转移灶，以及多发病灶合计直径小于4cm者射频消融治疗较为适用，可有显著生存获益。部分患者可迭临床治愈。对于胃癌肝转移的合适病例，射频消融治疗值得推广。

Clinical Significance of Intraoperative Radiofrequency Thermal Ablation for Synchronous Hepatic Metastasis from Gastric Cancer

Objective： To investigate the clinical significance of synchronous radiofrequency thermal ablation in hepatic metastasis of gastric cancer during radical gastrectomy. Methods： 19 gastric cancer patients with 33 hepatic metastasis from Jan 2008 to Dec 2010 were studied. Radiofrequency thermal ablation was undertaken under the ultrasonic guidance. Three cases had long survival without evidence of recurrence. Disease flee survival, hepatic specific survival and overall survival were accessed by Kaplan-Meier method. The clinicopathological factors and hepatic metastasis factors were evaluated by univariate and multivariate analyses by log-rank test in the Cox＇s proportional hazard model. Results： The median disease free, hepatic specific recurrent free and overall survival was 355 days, 394 days and 488 days, respectively. Univariate analysis showed that earlier T and N stage, less hepatic nodule number, smaller lesion diameter sum were associated with a favorable outcome. Multivariate analysis indicated the latter two factors as independent prognostic factors. Conclusion： Radiofrequency thermal ablation scheme was safe, and the utility was helpful in Hepatic metastasis gastric cancer especially those with solitary lesion of less than 4 cm, in multi-nodule cases, nodular with their sum-up diameter of less than 4 cm were two favorable prognostic factors for hepatic metastasis..