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中华介入放射学电子杂志

中华介入放射学电子杂志 ›› 2014, Vol. 02 ›› Issue (02) : 13 -18. doi: 10.3877/cma.j.issn.2095-5782.2014.02.004

所属专题： 文献；

肿瘤介入

肝动脉化疗栓塞联合同步DSA-CT引导下射频消融治疗大肝癌的临床研究
王志军1, 王茂强1,†(), 段峰1, 宋鹏1, 刘凤永1, 常中飞1, 王燕1, 阎洁羽1, 李凯1   
  1. 1. 100853　北京，中国人民解放军总医院介入放射科
  • 收稿日期:2013-06-09 出版日期:2014-05-01
  • 通信作者: 王茂强

Single-session combined therapy with chemoembolization and DSA-CT guided radiofrequency ablation in hepatocellular carcinoma larger than 5 cm: A primary clinical study

Zhijun Wang1, Maoqiang Wang1,†(), Feng Duan1, Peng Song1, Fengyong Liu1, Yan Wang1, Jieyu Yan1, Kai Li1   

  1. 1. Department of Interventional Radiology, PLA General Hospital, Beijing 100853, China
  • Received:2013-06-09 Published:2014-05-01
  • Corresponding author: Maoqiang Wang
  • About author:
    Corresponding author: Wang Maoqiang, Email:
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引用本文：

王志军, 王茂强, 段峰, 宋鹏, 刘凤永, 常中飞, 王燕, 阎洁羽, 李凯. 肝动脉化疗栓塞联合同步DSA-CT引导下射频消融治疗大肝癌的临床研究[J]. 中华介入放射学电子杂志, 2014, 02(02): 13-18.

Zhijun Wang, Maoqiang Wang, Feng Duan, Peng Song, Fengyong Liu, Yan Wang, Jieyu Yan, Kai Li. Single-session combined therapy with chemoembolization and DSA-CT guided radiofrequency ablation in hepatocellular carcinoma larger than 5 cm: A primary clinical study[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2014, 02(02): 13-18.

目的

评估肝动脉化疗栓塞（TACE）联合同步DSA-CT引导下射频消融（RFA）治疗大肝癌（肿瘤最大直径≥5 cm）的安全性和疗效。

方法

2010年1月～2012年3月21例原发性肝细胞癌患者接受同步联合治疗。术后定期进行影像学检查并复查甲胎蛋白，评估联合技术成功率、局部肿瘤治疗反应、无疾病复发时间、患者存活情况和技术相关并发症。

结果

技术成功率100%，无重要并发症发生。介入术后1个月复查，病灶完全缓解19例（19/21，90.48%）、部分缓解2例（2/21，9.52%）。肿瘤坏死以凝固性坏死为主。在局部灭活肿瘤方面，单结节型完全坏死率（17/17，100%）高于多结节性病灶(2/4,50.00%；P=0.034）。随访2～28个月，19例完全缓解者平均无疾病复发时间为（11.8±6.0）个月。21例患者6、12、18个月生存率均为100%。

结论

TACE联合同步DSA-CT引导下RFA治疗大肝癌安全、有效。局部肿瘤灭活方面，单结节型病灶优于多结节病灶。

关键词: 癌，肝细胞, 化学栓塞，治疗性, 导管消融, 同步
Objective

To assess the safety and efficacy of single-session combined therapy with transcatheter arterial chemoembolization (TACE) and DSA-CT guided radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) larger than 5 cm.

Methods

A total of 21 patients were treated with TACE immediately followed by DSA-CT-guided RFA. Rate of technical success, local-regional tumor response, recurrence-free survival time, survival rate and complications were evaluated at follow-up images and AFP (α-fetoprotein).

Results

Technical success was achieved in all 25 visible HCC. No major complications was observed in any patient. Nineteen patients were complete response (CR) and 2 were partial response (PR) after the 1st months. Coagulation necrosis was the major appearance. CR occupied 90.48% (19/21). PR occupied 9.52% (2/21). Local-regional tumor response in solitary nodular lesions (17/17, 100%) was superior to multiple nodular lesions (2/4, 50.00%; P=0.034). During follow-up period, mean recurrence-free survival time was 11.8±6.0 months in 19 cases with CR. The estimated overall survival rate at 6, 12 months and 18 months was 100%.

Conclusions

Single-session combined therapy with TACE and DSA-CT guided RFA in large hepatocellular carcinoma was safe and effective, especially for solitary nodular lesions.

Key words: Carcinoma, hepatocellular, Chemoembolization, therapeutic, Catheter ablation, Single-session
表1 21例患者及病变联合治疗前基本特征
参数 数值
年龄[范围（平均），岁] 38~67（48.3±9.4）
性别[例（%）] ?
? 男性 17（81%）
? 女性 4（19%）
Child–Pugh分级[例（%）] ?
? A 16（76%）
? B 5（24%）
肝硬化病因[例（%）] ?
? 乙肝 14（67%）
? 丙肝 5（23%）
? 乙肝合并丙肝 2（10%）
甲胎蛋白（ng/ml）[例（%）] ?
? ≤20 8（38%）
? >20 13（62%）
病灶部位[例（%）] ?
? 近膈下 9 （43%）
? 非膈下 16 （57%）
最大直径[例（%）] ?
? 5~10 cm 16（57%）
? >10 cm 9（43%）
病灶个数 ?
? 1个 17
? 2个 4
既往TACE情况（例） ?
? 1次 10
? 2次 6
? 3次 3
? 4次 2
表2 联合技术对不同类型肿瘤病灶的彻底灭活能力
病灶类型 肿瘤彻底灭活能力 合计
CR PR
单结节型 17 0 17
多结节型 2 2 4
合计 19 2 21
图1 患者男性，60岁，原发性肝细胞癌，首次介入治疗后复查CT显示肝内可见残留病灶，遂行DSA-CT引导下同步TACE和RFA治疗　A.首次介入后肝脏CT平扫显示：肝内碘油部分沉积(箭)；B. RFA前血管造影显示：肝内碘油沉积，动脉晚期可见肿瘤内及周边片状肿瘤染色(箭)；C/D.应用INNOVA4100 IQ血管造影机DSA-CT功能，取重建矢状面和横断面病灶重建图像，建立进针路线和角度(箭)；E/F.联合治疗后23个月肝脏CT平扫，可见肝内碘油沉积良好，未见动脉血供（箭）
图2 患者男性，42岁，低分化肝细胞癌首次介入1次后复查肝脏CT显示肝内残留病灶，AFP 345 μg/ml遂行联合TACE和RFA　A.介入前CT可见动脉期肝右叶巨大富血供占位病变(箭)；B.首次介入后肝内肿块周边可见碘油沉积，CT动脉期可见残留强化病灶(箭)；C. RFA前常规TACE造影显示：肝内及肝脏病灶周边可见残留肿瘤病灶染色(箭)；D/E.针对TACE后碘油沉积范围，设计两个多极针（最大展开直径5 cm，覆盖原有病灶和残留病灶）分别进行RFA。病灶累及膈顶，透视下避开肺组织进行穿刺(箭)；F/G.联合治疗后15个月复查肝脏病灶控制良好，未见复发(箭)
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