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【目的】研究建立超声引导射频消融复发率较高的肝肿瘤 (>3.5cm)的治疗方案 ,评价临床应用效果。【方法】根据治疗范围至少达肿瘤周边 0 .5～ 1.0cm的原则 ,采用 5cm消融灶设计不同大小肿瘤重叠消融的方案。按照数学模型计算建立的治疗方案包括覆盖肿瘤所需的最少消融灶数目、定位模式及实施程序。设立易于把握的实际布针方法。临床应用对象为根据计算方案治疗的原发性肝癌患者 83例及肝转移癌患者 5 8例 ,计 14 1例 16 2个肿瘤 ,大小为 3.6～ 7.7(4 .79± 0 .96 )cm。【结果】16 2个肿瘤共穿刺消融 712个球灶。治疗后 1个月CT检查显示肿瘤完全灭活率达 90 .1% (14 6 /16 2灶 ) ,随访 3～ 38个月 ,局部复发率为 2 1.0 % (34/16 2灶 ) ,其中肝转移癌高于原发癌 (P <0 .0 5 ) ;2 6例因肿瘤复发共进行了 39次再次治疗 ,其中 18例再治疗 1次 ,8例再次治疗 2～ 3次。严重并发症为 4 .9% (7/14 1例 ) ,仅 1例复发癌再治疗 1周后肠穿孔需外科手术治疗。【结论】本计算方案的制定为超声引导射频消融治疗 3.5cm以上肝肿瘤提供了依据 ,并可指导临床实际应用。治疗结果显示该方案可显著提高肝肿瘤消融灭活率 ,减少复发 ,具有较高的临床应用。
【OBJECTIVE】 To establish a therapeutic regimen of ultrasound-guided liver tumor (> 3.5cm) with high recurrence rate of radiofrequency ablation and evaluate the clinical effect. 【Methods】 According to the principle that the treatment range was at least 0.5 ~ 1.0cm around the tumor, a 5cm ablation stove was designed to overlap and ablate tumor of different sizes. The treatment plan, calculated on the mathematical model, includes the minimum number of lesions needed to cover the tumor, the positioning pattern, and the procedure to be performed. Set up easy to grasp the actual cloth needle method. Among 83 patients with primary hepatic cancer and 58 patients with metastatic liver cancer undergoing therapy, 14.1162 tumors (size 3.6-7.7 (4.79 ± 0.96) cm) were enrolled in this study. 【Results】 A total of 712 lesions were ablated in 16 2 tumors. CT examination at 1 month after treatment showed that the complete tumor inactivation rate was 90.1% (14 6/16) and the follow-up ranged from 3 to 38 months. The local recurrence rate was 2 1.0% (34/16 2) Liver metastases were higher than primary cancers (P <0.05). Twenty-six of the 26 patients were re-treated due to tumor recurrence, of which 18 were re-treated once and 8 were re-treated 2 or 3 times. Severe complications were 4.9% (7/14 1 case), only 1 case of recurrence of cancer re-treatment after 1 week of intestinal perforation required surgical treatment. 【Conclusion】 The formulation of this calculation provides the basis for ultrasound-guided radiofrequency ablation for the treatment of 3.5 cm or more liver tumors, and can guide the clinical practice. Treatment results show that the program can significantly improve the rate of inactivation of liver tumor ablation, reduce recurrence, with high clinical application.