摘要
目的评价经皮氩氦刀治疗原发性肝癌(HCC)的疗效、安全性及并发症。方法采用氩氦超导手术系统,在B超引导下经皮氩氦刀治疗300例HCC患者,观察其治疗效果及随访情况。结果165例患者的223个瘤体(直径7.2±2.8cm,5.0～15cm)未被彻底毁损,135例的185个瘤体(直径5.6±0.8cm,1.9～7.0cm)被完全毁损,两组肿瘤直径差异显著(P=0.000 1)。265例患者随访中位时间为31.2(6～63)个月,彻底毁损组(经氩氦刀治疗后肿瘤被完全毁损)肿瘤原位复发率为16.3%(22/135),肝动脉化疗栓塞(TACE)组(经氩氦刀治疗后肿瘤未被完全毁损,再联合TACE治疗)原位复发率为47.1%(41/87),两组肿瘤原位复发率差异显著(P=0.000 1)。早期、中期、进展期肝癌(巴塞罗纳肝癌分期标准)术后生存期分别为38.7±3.8、26.5±4.2、16.9±1.4个月。17例(5.7%)发生严重并发症,包括冷休克6例(2.0%)、肝癌破裂出血5例(1.7%)、应激性胃黏膜出血4例(1.3%)、肝功能衰竭2例(0.7%)。术后肝功能多有轻度损害,2周左右恢复至术前的基线水平。结论经皮氩氦刀治疗肝癌是一种较安全有效的方法,肿瘤直径和肿瘤分期是影响疗效的主要因素。
Objective To evaluate the therapeutic effect, safety and complication of percutancous argon-helium cryoablation in the treatment of primary hepatocellular cancer （HCC）. Methods Three hundred HCC patients were treated with percutaneous argon-helium cryoablation under ultrasound guidance with argon-helium cryosurgical system. Results Two hundred and thirty-three tumors （diameter ranged from 5.0cm to 15cm, with a mean of 7.2cm±2.8cm）, in 165 patients were considered to be incompletely ablated, while 185 tumors （diameter ranged from 1.9cm to 7.0cm with mean value of 5.6cm±0.8cm） in 135 patients were completely ablated. There was a signifi- cant difference in tumor diameter between these two groups （P〈0.01）. Aher cryoablation, the mean follow-up period in 265 patients was 31.2 months （ranged from 6 to 63 months）. All the 265 patients followed up were assigned into 3 groups： complete ablation group, TACE group （transarterial chemoembolization）, and incomplete ablation group （argon helium cryosurgical plus TACE）. The irrsitu recurrence rate in complete ablation group and incomplete ablation group was 16.3% （22/135） and 47.1% （41/87）, respectively, and the difference was statistically significant （P〈0.01）. After the treatment, the mean survival period for the patients with HCC at early stage, intermediate stage and advanced stage （according to Barcelona-Clinic-Liver-Cancer staging system） was 38.7±3.8 months, 26.5±4.2 months and 16.9±1.4 months, respectively. Serious complications were found in 17 patients （5.7%）, including 6 cases of cold shock （2.0%）, 5 cases of bleeding for ruptare of the tumor （1.7%）, 4 eases of Needing from stress gastric ulcer （1.3%） and 2 cases of liver failure （0.7%）. The serum alanine aminotransferase （ALT） and total bilirubin （TBIL） levels were transiently elevated one day after cryoablation in all the patients, but declined to baseline in 2 weeks. Conclusions Percutaneous argon-helium cryoablation is an effective and safe non-operative treatment for HCC. Tumor diameter and tumor stage are the most important factors influencing the therapeutic efficacy of cryoablation.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2008年第12期1413-1417,共5页
Medical Journal of Chinese People's Liberation Army
基金
国家"863"计划资助项目(2003AA208106)
军队医学杰出人才基金资助项目(04J020)
关键词
冷冻外科手术
癌
肝细胞
治疗结果
cryosurgery
carcinoma, hepatocellular
treatment outcome
