探讨经导管动脉化疗栓塞术（transarterial chemoembolization, TACE）联合锥形束计算机断层扫描（cone-beam computed tomography, CBCT）引导下经皮无水乙醇注射术（percutaneous ethanol injection, PEI）同步治疗危险部位小肝癌的临床疗效与安全性。

回顾性分析2019年1月至2023年12月苏州大学附属第一医院介入科接受CBCT引导下TACE联合PEI同步治疗的61例危险部位小肝癌患者（共64个病灶）的临床资料。于术后1、3、6、12个月进行随访，采用改良实体瘤评价标准判定肿瘤是否完全消融，计算初始完全消融率、二次完全消融率及最终完全消融率；分析无复发生存期（recurrence-free survival, RFS）、局部肿瘤进展（local tumor progression, LTP）及不良反应。

TACE联合CBCT引导下PEI同步治疗危险部位小肝癌的技术操作成功率为100%。初始完全消融率为93.8%（60/64）；4个病灶未达完全消融，经追加PEI治疗后均达到完全消融，最终完全消融率达100%。至随访截止，61例患者（64个病灶）中，肿瘤复发率为44.3%（27/61），LTP发生率为19.7%（12/61）。平均RFS为34.75个月（95% CI: 28.99 – 40.50），平均至LTP时间为45.33个月（95% CI: 39.51 – 51.15）。单因素及多因素分析显示，肿瘤最大直径（≥2 cm且<3 cm）是影响RFS的独立危险因素（P<0.001）。研究中未发生严重不良事件。

TACE联合CBCT引导下PEI同步治疗危险部位小肝癌安全有效。

To assess the clinical efficacy and safety of transarterial chemoembolization (TACE) combined with cone-beam computed tomography (CBCT)–guided percutaneous ethanol injection (PEI) performed simultaneously for small hepatocellular carcinomas (HCCs) located in high-risk areas.

A retrospective study was conducted on 61 patients (64 lesions) with high-risk HCC who underwent simultaneous CBCT-guided TACE and PEI at the Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, between January 2019 and December 2023. Follow-up evaluations were performed at 1, 3, 6, and 12 months after treatment. Complete ablation was determined based on the absence of arterial enhancement according to mRECIST criteria. The initial complete ablation rate, secondary complete ablation rate, and final complete ablation rate were calculated. Recurrence-free survival (RFS), local tumor progression (LTP), and adverse events were also analyzed.

The technical success rate was 100%. The initial complete ablation rate was 93.8% (60/64). Four lesions did not achieve complete ablation after the initial treatment; all subsequently achieved complete ablation following additional PEI, resulting in a final complete ablation rate of 100%. At the end of follow-up, among 61 patients (64 lesions), the overall tumor recurrence rate was 44.3% (27/61), and the incidence of LTP was 19.7% (12/61). The mean RFS was 34.75 months (95% CI: 28.99–40.50), and the mean time to LTP was 45.33 months (95% CI: 39.51–51.15). Both univariate and multivariate analyses demonstrated that maximum tumor diameter (≥2 cm and <3 cm) was an independent risk factor for RFS (P < 0.001). No severe treatment-related adverse events occurred during or after the procedure.

Simultaneous TACE combined with CBCT-guided PEI is a safe and effective therapeutic approach for small HCCs in high-risk anatomical locations, achieving excellent tumor control with minimal complications.