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目的 探讨对于无手术指征或考虑手术疗效欠佳的较大肝癌 (3～ 7cm)和位于肝门区的小肝癌先行肝动脉化疗栓塞 (TACE) ,再行B超引导经皮肝穿刺射频热凝 (PRFA)治疗肝癌的意义。方法 2 0 0 0年 1月至 2 0 0 1年 7月对符合条件的 1 5例肝癌患者先行TACE ,而后进行B超引导PRFA治疗 ,另 1 5例肝癌患者直接给予B超引导PRFA治疗。治疗后定期复查甲胎蛋白 (AFP)。 1个月后复查MRI或CT确定肿瘤是否完全坏死 ,以后每 2～ 3个月复查。Kaplan Meier法计算无瘤生存率和累积生存率。 结果 TACE加PRFA组肿瘤完全坏死率 86 7% (1 3/ 1 5) ,单纯PRFA组为 2 6 7% (4/ 1 5) ,差异有显著意义。前组AFP转阴率 66 7% (6/ 9) ,后组 2 0 % (2 / 1 0 )。前组 6个月无瘤生存率 1 0 0 % (1 3/1 3) ,后组 75 0 % (3/ 4 )。前组 1、1 5、2年的生存率分别为 1 0 0 %、1 0 0 %和 66 7% ,后组 1和 1 5年的生存率分别为 80 0 %和 40 0 % ,差异有显著意义。 结论 对于较大的 (>3cm)、位于肝门区的、边界不清的或较多个瘤灶的肝癌先行TACE ,再适时给予PRFA ,可以扩大肿瘤坏死范围 ,增加肿瘤完全坏死率、减少复发、提高生存率
Objective To investigate the feasibility of transcatheter hepatic arterial chemoembolization (TACE) for advanced hepatocellular carcinoma (3 ~ 7 cm) and small hepatocellular carcinoma Condensation (PRFA) in the treatment of liver cancer. Methods From January 2000 to July 2001, TACE was performed on the eligible liver cancer patients and then B ultrasound guided PRFA. The other 15 liver cancer patients were given B ultrasound guided PRFA directly. After treatment regular review of alpha-fetoprotein (AFP). 1 month after the review MRI or CT to determine whether the tumor is completely necrosis, after every 2 to 3 months review. Kaplan-Meier method to calculate the free survival rate and cumulative survival rate. Results The complete tumor necrosis rate of TACE plus PRFA group was 86.7% (1 3/1 5), and that of PRFA group alone was 26.7% (4/15). The difference was significant. The AFP negative rate in the former group was 66 7% (6/9) and that in the latter group 20% (2/10). The 6-month disease-free survival rate was 100% (1 3/1 3) in the anterior group and 75 0% (3/4) in the latter group. The survival rates at 1, 5, and 2 years in the former group were 100%, 100% and 667% respectively, while the survival rates at 1 and 15 years in the latter group were 80% and 40% respectively Significant. Conclusions For large (> 3cm) HCCs with unclear boundary or more tumorous lesions, TACE can be extended first and then PRFA can be extended to increase tumor necrosis, increase complete tumor necrosis and reduce recurrence , Improve survival rate